Organization
PACIFIC MINIMALLY INVASIVE SURGEONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA E DUDZIAK MD (PRESIDENT)
(909) 599-6784
Entity
Organization
Contact information
Practice address
1330 W COVINA BLVD, SUITE 101, SAN DIMAS, CA 91773-3200
(909) 599-6784
(909) 599-7073
Mailing address
1330 W COVINA BLVD, SUITE 101, SAN DIMAS, CA 91773-3200
(909) 599-6784
(909) 599-7073
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A87866
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8G0894
MEDICARE ID TYPE UNSPECIF
TX
Enumeration date
07/16/2007
Last updated
07/16/2007
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