Healthcare Provider Details

I. General information

NPI: 1730578253
Provider Name (Legal Business Name): TWIN PELICAN SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 EASTERN AVE STE 102
BELL GARDENS CA
90201-5464
US

IV. Provider business mailing address

7916 EASTERN AVE STE 102
BELL GARDENS CA
90201-5464
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-7060
  • Fax:
Mailing address:
  • Phone: 562-928-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA52488
License Number StateCA

VIII. Authorized Official

Name: DR. FRED SAHAFI
Title or Position: MEDICAL DIRECTOR/ OWNER
Credential: M.D
Phone: 562-928-7060