Organization
BLUE WAVE SURGICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER SOROKURS M.D. (PRESIDENT)
(310) 622-5369
Entity
Organization
Contact information
Practice address
25043 NARBONNE AVE # A, LOMITA, CA 90717-2101
(818) 986-9918
Mailing address
4910 VAN NUYS BLVD STE 306, SHERMAN OAKS, CA 91403-1770
(818) 986-9918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A54193
CA
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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