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General NPI Number Information
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NPI Number | 1073795498
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Entity Type | Organization
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Legal Business Name | LONG BEACH SURGICAL GROUP A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1040 ELM AVE SUITE #303
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City | LONG BEACH
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State | CA
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Zip | 90813-3264
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Country | US
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Telephone | 562-436-9645
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Fax | 562-436-7119
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Provider Business Mailing Address
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Address Line | 1040 ELM AVE SUITE #303
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City | LONG BEACH
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State | CA
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Zip | 90813-3264
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Country | US
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Telephone | 562-436-9645
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Fax | 562-436-7119
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LINDA ROSE
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Credential |
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Telephone | 562-436-9645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C25484
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License Number State | CA
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