Healthcare Provider Details

I. General information

NPI: 1356101430
Provider Name (Legal Business Name): LONG BEACH SURGICARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ATLANTIC AVE STE 101
LONG BEACH CA
90807-2260
US

IV. Provider business mailing address

4401 ATLANTIC AVE STE 101
LONG BEACH CA
90807-2260
US

V. Phone/Fax

Practice location:
  • Phone: 562-573-4545
  • Fax: 562-253-0330
Mailing address:
  • Phone: 562-573-4545
  • Fax: 562-253-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PEDRAM ENAYATI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-409-3611