Provider Demographics
NPI:1386134062
Name:SHORELINE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SHORELINE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-588-7296
Mailing Address - Street 1:4300 LONG BEACH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2016
Mailing Address - Country:US
Mailing Address - Phone:562-857-1928
Mailing Address - Fax:
Practice Address - Street 1:4300 LONG BEACH BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2016
Practice Address - Country:US
Practice Address - Phone:562-857-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty