Healthcare Provider Details

I. General information

NPI: 1063825255
Provider Name (Legal Business Name): NIGAL SURFIAN ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16041 MARJAN LN
HUNTINGTON BEACH CA
92647-3423
US

IV. Provider business mailing address

16041 MARJAN LN
HUNTINGTON BEACH CA
92647-3423
US

V. Phone/Fax

Practice location:
  • Phone: 714-390-7070
  • Fax:
Mailing address:
  • Phone: 714-390-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number36667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: