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General NPI Number Information
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NPI Number | 1891377339
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Entity Type | Organization
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Legal Business Name | AIRPORT URGENT CARE SURGERY CENTER
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 1117 W MANCHESTER BLVD STE M
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City | INGLEWOOD
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State | CA
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Zip | 90301-1596
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Country | US
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Telephone | 310-299-5404
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Fax | 310-602-6287
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Provider Business Mailing Address
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Address Line | PO BOX 11147
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City | MARINA DEL REY
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State | CA
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Zip | 90295-7147
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Country | US
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Telephone | 310-299-5404
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Fax | 310-602-6287
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMSHID SHARIATI
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Credential | MD
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Telephone | 310-403-7809
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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 |
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License Number State |
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