Organization
SOUTHERN CALIFORNIA SURGICAL INC
Active
Other names
Southen California Surgical Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WANNARES MD (PRESIDENT)
(508) 898-0986
Entity
Organization
Contact information
Practice address
8554 LA MESA BLVD, LA MESA, CA 91942-9558
(619) 464-4469
(619) 713-0479
Mailing address
6415 REFLECTION DR APT 206, SAN DIEGO, CA 92124-3167
(508) 898-0986
(619) 330-2245
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851728141
MEDICARE
CA
05
—
1851728141
—
CA
Enumeration date
05/15/2020
Last updated
05/15/2020
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