Organization Name: | SURGICAL TREATMENT AND REGENERATION II, LLC |
NPI Number: | 1174987135 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NEIL GHODADRA (MEDICAL DIRECTOR) |
Mailing Address: | 2711 N Sepulveda Blvd #223 Manhattan Beach |
State: | CA US |
Postal Code: | 902662725 |
Phone Number: | 7603753974 |
Fax Number: | 7603753953 |
NPI Enumeration Date: | 04/06/2016 |
NPI Last Update Date: | 04/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |