Provider Demographics
NPI:1306031034
Name:PACIFIC COAST SURGICAL CENTER LP
Entity Type:Organization
Organization Name:PACIFIC COAST SURGICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RIFAAT
Authorized Official - Middle Name:DOVER
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:310-802-6260
Mailing Address - Street 1:3720 LOMITA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3884
Mailing Address - Country:US
Mailing Address - Phone:310-802-6260
Mailing Address - Fax:310-802-6268
Practice Address - Street 1:3720 LOMITA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3884
Practice Address - Country:US
Practice Address - Phone:310-802-6260
Practice Address - Fax:310-802-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1969Medicare PIN
CAS051677Medicare PIN