Provider Demographics
NPI:1730729690
Name:PRECISION PHYSICIANS SURGICAL GROUP CORP.
Entity type:Organization
Organization Name:PRECISION PHYSICIANS SURGICAL GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REETU
Authorized Official - Middle Name:
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-815-6466
Mailing Address - Street 1:PO BOX 8636
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8636
Mailing Address - Country:US
Mailing Address - Phone:770-815-6466
Mailing Address - Fax:
Practice Address - Street 1:110 JENSEN CT STE 1C
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7484
Practice Address - Country:US
Practice Address - Phone:678-596-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty