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General NPI Number Information
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NPI Number | 1730578253
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Entity Type | Organization
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Legal Business Name | TWIN PELICAN SURGICAL GROUP
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 7916 EASTERN AVE STE 102
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City | BELL GARDENS
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State | CA
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Zip | 90201-5464
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Country | US
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Telephone | 562-928-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 7916 EASTERN AVE STE 102
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City | BELL GARDENS
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State | CA
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Zip | 90201-5464
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Country | US
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Telephone | 562-928-7060
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/ OWNER
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Name | DR. FRED SAHAFI
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Credential | M.D
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Telephone | 562-928-7060
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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 | A52488
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License Number State | CA
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