NPIMap

Organization Active NPI

Southern California Surgical Inc

  • Surgery Physician
  • La Mesa, CA
National Provider Identifier
1861014599
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SOUTHERN CALIFORNIA SURGICAL INC
Practice address
8554 La Mesa Blvd
La Mesa, CA 91942-9558
Phone
(619) 464-4469
Fax
(619) 713-0479
NPI assigned
May 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Authorized official

Name
Dr. Jeffrey Wannares, MDNPI 1851728141
Title
President
Phone
(508) 898-0986

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

8554 La Mesa Blvd
La Mesa, CA 91942-9558

Mailing address

6415 Reflection Dr Apt 206
San Diego, CA 92124-3167
Phone (508) 898-0986

Other identifiers 2

IdentifierTypeStateIssuer
1851728141OtherCAMEDICARE
1851728141MedicaidCA

Other names 1

  • Southen California Surgical Inc Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1861014599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 REFLECTION DR APT 206",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243167",
            "telephone_number": "508-898-0986",
            "fax_number": "619-330-2245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8554 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919429558",
            "telephone_number": "619-464-4469",
            "fax_number": "619-713-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA SURGICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "WANNARES",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-898-0986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1851728141",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851728141",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southen California Surgical Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.