Surgical Physician Assistant Specialist, Inc.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.

Practice address

5555 Grossmont Center Dr
La Mesa, CA 91942-3019

Phone

(619) 740-6000

NPI assigned

Jun 4, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Zachary PeriharosNPI 1285185397

Title

Owner

Phone

(530) 232-5985

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zachary Periharos, PA-C

  • Physician Assistant
  • La Mesa, CA
  • NPI 1285185397
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769040000000",
    "number": "1619544178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 21ST ST # 11082",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423019",
            "telephone_number": "619-740-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-04",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A",
        "authorized_official_last_name": "PERIHAROS",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-232-5985"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.