Healthcare Provider Details

I. General information

NPI: 1407813066
Provider Name (Legal Business Name): GREATER LONG BEACH ENDOSCOPY AND SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE SUITE 180
LONG BEACH CA
90806-1714
US

IV. Provider business mailing address

2880 ATLANTIC AVE SUITE 180
LONG BEACH CA
90806-1714
US

V. Phone/Fax

Practice location:
  • Phone: 562-462-2606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: RICHARD L SHARFF JR.
Title or Position: VP/SECRETARY
Credential:
Phone: 205-545-2572