Healthcare Provider Details

I. General information

NPI: 1669869111
Provider Name (Legal Business Name): LB SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE 180
LONG BEACH CA
90806-1714
US

IV. Provider business mailing address

PO BOX 881840
LOS ANGELES CA
90009-3013
US

V. Phone/Fax

Practice location:
  • Phone: 562-330-2800
  • 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: ERIK SIMMONS
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-674-0144