| NPI | 1841623865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN R SHACKFORD Owner/President 619-299-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G29279) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G29279) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2013-08-13 |