Organization
LONG BEACH SURGICAL GROUP A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA ROSE (OFFICE MANAGER)
(562) 436-9645
Entity
Organization
Contact information
Practice address
1040 ELM AVE, SUITE #303, LONG BEACH, CA 90813-3264
(562) 436-9645
(562) 436-7119
Mailing address
1040 ELM AVE, SUITE #303, LONG BEACH, CA 90813-3264
(562) 436-9645
(562) 436-7119
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C25484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C254840
—
CA
05
—
GR0014610
—
CA
Enumeration date
11/27/2007
Last updated
10/05/2012
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