Healthcare Provider Details

I. General information

NPI: 1639419104
Provider Name (Legal Business Name): COMPLETE CARE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 LONG BEACH BLVD STE 101
LONG BEACH CA
90807-3315
US

IV. Provider business mailing address

3650 SOUTH ST STE 403
LAKEWOOD CA
90712-1502
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-8422
  • Fax:
Mailing address:
  • Phone: 562-634-8812
  • Fax: 562-634-6033

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. MIRIAM MACKOVIC-BASIC
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-634-8812