=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023829447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEA SURGICAL INSTITUTE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7801 CENTER AVE STE 102
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-9112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-855-1507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6789 QUAIL HILL PARKWAY STE 102
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-9264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-855-1507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | MISS PELIN SEN
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 818-855-1507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------