Healthcare Provider Details

I. General information

NPI: 1508293853
Provider Name (Legal Business Name): ADMIRALTY SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 ADMIRALTY WAY SUITE 718B
MARINA DEL REY CA
90292-6621
US

IV. Provider business mailing address

4640 ADMIRALTY WAY SUITE 718B
MARINA DEL REY CA
90292-6621
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-4444
  • Fax: 310-363-7085
Mailing address:
  • Phone: 310-823-4444
  • Fax: 310-363-7085

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. FARHAD SIAGRI
Title or Position: OWNER
Credential:
Phone: 310-823-4444