Provider Demographics
NPI:1154554160
Name:CABRILLO SURGERY CENTER
Entity type:Organization
Organization Name:CABRILLO SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-278-8835
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-278-8835
Mailing Address - Fax:858-386-4776
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-278-8835
Practice Address - Fax:858-386-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78569261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical