Organization
MDR SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS H MACIAS MD (PRESIDENT)
(310) 995-5071
Entity
Organization
Contact information
Practice address
13160 MINDANAO WAY STE 202, MARINA DEL REY, CA 90292-7915
(310) 574-2103
(310) 640-6069
Mailing address
13160 MINDANAO WAY STE 202, MARINA DEL REY, CA 90292-7915
(310) 574-2103
(310) 640-6069
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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