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General NPI Number Information
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NPI Number | 1013275965
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Entity Type | Organization
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Legal Business Name | SOMA SURGERY CENTER INC.
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 8929 WILSHIRE BLVD STE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1950
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Country | US
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Telephone | 310-855-8936
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Fax | 413-643-6360
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Provider Business Mailing Address
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Address Line | 2160 CENTURY PARK E APT 602
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City | LOS ANGELES
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State | CA
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Zip | 90067-2214
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Country | US
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Telephone | 310-673-0523
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Fax | 413-643-6360
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN S RAVAEI
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Credential |
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Telephone | 310-673-0523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 00014995
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License Number State | CA
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