Healthcare Provider Details

I. General information

NPI: 1881834596
Provider Name (Legal Business Name): LONG BEACH OUT PT SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 LONG BEACH BLVD
LONG BEACH CA
90806-3260
US

IV. Provider business mailing address

2370 LONG BEACH BLVD
LONG BEACH CA
90806-3260
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-9493
  • Fax: 562-595-9837
Mailing address:
  • Phone: 562-595-9493
  • Fax: 562-595-9837

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. PEARLMAN D HICKS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 562-595-9493