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Organization
PACIFIC SURGICAL SPECIALISTS MEDICAL GROUP, INC
Active
Organization
PACIFIC SURGICAL SPECIALISTS MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY K WILDE MD (PRESIDENT)
(858) 623-2345
Entity
Organization
Contact information
Practice address
9850 GENESEE AVE, 510, LA JOLLA, CA 92037-1224
(858) 623-2345
(858) 623-2343
Mailing address
9850 GENESEE AVE, 510, LA JOLLA, CA 92037-1224
(858) 623-2345
(858) 623-2343
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G65602
CA
Other
Enumeration date
03/17/2008
Last updated
03/17/2008
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