SOUTHERN CALIFORNIA SURGICAL INC (NPI# 1861014599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861014599 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CALIFORNIA SURGICAL INC |
| Practice Address |
8554 La Mesa Blvd La Mesa CA 91942-9558 |
| Mailing Address |
6415 Reflection Dr Apt 206 San Diego CA 92124-3167 |
| Practice Telephone | 6194644469 |
| Practice Fax Number | 6197130479 |
| Mailing Telephone | 5088980986 |
| Mailing Fax Number | 6193302245 |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-05-15 |
| Authorized Official Name | DR. JEFFREY WANNARES (PRESIDENT) |
| Authorized Official Telephone | 5088980986 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1851728141 | 05 | |
| CA | MEDICARE | 1851728141 | 01 |
| Other Name | Type Code |
|---|---|
| Southen California Surgical Inc | Former Legal Business Name - Organization |
| Street Address |
8554 LA MESA BLVD |
| City | LA MESA |
| State | CA |
| Zip Code | 91942-9558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386737773 | Phillip Dickinson | Family Medicine | 8554 La Mesa Blvd, La Mesa, CA 91941 | 2006-09-30 |
| 1851728141 | Jeffrey Wannares | Surgery | 8554 La Mesa Blvd, La Mesa, CA 91942-9558 | 2013-10-01 |
| 1447501507 | Sinafikish T Tessema | Nurse Practitioner | 8554 La Mesa Blvd, La Mesa, CA 91942-9558 | 2012-09-28 |
| 1962734186 | La Mesa Surgical Services | Specialist | 8554 La Mesa Blvd, La Mesa, CA 91942-9558 | 2010-02-12 |
| 1467600270 | Phillip Dickinson, M.d., A Professional Corporation | Surgery | 8554 La Mesa Blvd, La Mesa, CA 91941-3958 | 2008-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902453723 | Nicole V Zappelli | Case Manager/Care Coordinator | 4990 William Ave., La Mesa, CA 91942 | 2019-08-26 |
| 1770059834 | Natalie Ngoc Nguyen | Physician Assistant | 5555 Grosmont Center Dr., La Mesa, CA 91942 | 2018-10-16 |
| 1194204297 | Courtney Pietsch | Nurse Practitioner | 8851 Health Center Circle, Suite #603, La Mesa, CA 91942 | 2018-08-09 |
| 1295214773 | Megan Gordon | Behavior Technician | 6116 Horton Dr, La Mesa, CA 91942 | 2018-08-07 |
| 1356836548 | Kimberly Denise Davis | Counselor | 3845 Avocado School Road, El Cajon, CA 91942 | 2018-06-29 |
| 1366932113 | Melanie Joyce Shepard | Physician Assistant | 7051 Alvarado Road, Suite 201, La Mesa, CA 91942 | 2018-05-17 |
| 1871013532 | Low Dental, A.p.c. | Public Health or Welfare | 7872 La Mesa Blvd., La Mesa, CA 91942 | 2017-06-23 |
| 1275069437 | Ardel Ayala | Respiratory Therapist, Registered | 5800 Lake Murray Blvd. Unit 15, La Mesa, CA 91942 | 2017-05-10 |
| 1285007583 | Counseling & Behavioral Specialists | Marriage & Family Therapist | 5520 Wellesley Street, Ste 204, La Mesa, CA 91942 | 2015-11-09 |
| 1285001875 | Emily Shozaki Rizo | Nurse Practitioner | 6285 Meadowcrest Drive, La Mesa, CA 91942 | 2015-08-31 |
| Find all providers in zip 91942 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982929329 | James Avery Johnson | Surgery | 8660 Sunrise Ln, La Mesa, CA 91941-5534 | 2010-03-29 |
| 1477672046 | Ronald M Johnson | Surgery | 5360 Jackson Drive, Ste 100, La Mesa, CA 91943 | 2007-03-28 |
| 1013924596 | Charles John Sarosy | Surgery | 8881 Fletcher Parkway/ Dr. Charles Sarosy, Suite241, La Mesa, CA 91942 | 2006-08-01 |
| 1487650412 | Yuan H Lin | Surgery | 5565 Grossmont Center Dr Building 1, Ste 221, La Mesa, CA 91942-3022 | 2005-06-23 |
| 1851728141 | Jeffrey Wannares | Surgery | 8554 La Mesa Blvd, La Mesa, CA 91942-9558 | 2013-10-01 |
| 1013269182 | Ronald M Johnson Md Medical Corp | Surgery | 5565 Grossmont Center Dr, La Mesa, CA 91942-3020 | 2012-10-12 |
| 1043445398 | Simon Lavotshkin | Surgery | 5565 Grossmont Center Drive, Bld #1 Suite 221, La Mesa, CA 91942 | 2009-05-15 |
| 1467600270 | Phillip Dickinson, M.d., A Professional Corporation | Surgery | 8554 La Mesa Blvd, La Mesa, CA 91941-3958 | 2008-09-04 |
| 1295827830 | Grossmont Surgical Associates,inc | Surgery | 5565 Grossmont Center Drive, Suite 1-221, La Mesa, CA 91942-3020 | 2006-09-29 |
| 1306957683 | Garo Yerevanian | Surgery | 5525 Grossmont Center Dr, La Mesa, CA 91942-3009 | 2006-08-31 |
| Find all providers in LA MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.