| Blue Wave Surgical Center, Inc. | |
|
25043 Narbonne Ave # A Lomita CA 90717-2101 | |
| (818) 986-9918 | |
| Not Available |
| Full Name | Blue Wave Surgical Center, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 25043 Narbonne Ave # A, Lomita, California |
| Authorized Official Name and Position | Alexander Sorokurs (PRESIDENT) |
| Authorized Official Contact | 3106225369 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Wave Surgical Center, Inc. 4910 Van Nuys Blvd Ste 306 Sherman Oaks CA 91403-1770 Ph: (818) 986-9918 | Blue Wave Surgical Center, Inc. 25043 Narbonne Ave # A Lomita CA 90717-2101 Ph: (818) 986-9918 |
| NPI Number | 1770840100 |
|---|---|
| Provider Enumeration Date | 04/23/2012 |
| Last Update Date | 04/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770840100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A54193 (California) | Primary |
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