Organization
BLUE WAVE SURGERY CENTER, INC.
Active
Parent organization
BLUE WAVE SURGERY CENTER, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLUE WAVE SURGERY CENTER, INC
Authorized official
DR. ALEXANDER SOROKURS M.D. (PRESIDENT)
(310) 622-5369
Entity
Organization
Contact information
Practice address
4910 VAN NUYS BLVD STE 306, SHERMAN OAKS, CA 91403-1770
(310) 622-5369
Mailing address
4910 VAN NUYS BLVD STE 306, SHERMAN OAKS, CA 91403-1770
(310) 622-5369
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A54193
CA
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A54193
CA
Other
Enumeration date
02/29/2012
Last updated
04/17/2012
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