Provider Demographics
NPI:1629103338
Name:MARINA OUTPATIENT SURGERY CENTER
Entity Type:Organization
Organization Name:MARINA OUTPATIENT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-827-3904
Mailing Address - Street 1:4560 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5423
Mailing Address - Country:US
Mailing Address - Phone:310-827-3904
Mailing Address - Fax:310-827-1493
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-827-3904
Practice Address - Fax:310-827-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical