Healthcare Provider Details

I. General information

NPI: 1659753358
Provider Name (Legal Business Name): ST. MICHAEL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST SUITE 300
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

701 E 28TH ST SUITE 300
LONG BEACH CA
90806-2759
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-7800
  • Fax:
Mailing address:
  • Phone: 562-427-7800
  • 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: DR. RAFAAT MATTAR
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 562-427-7800