Provider Demographics
NPI:1851508667
Name:SOUTH BAY SURGICAL AND SPINE INSTITUTE
Entity Type:Organization
Organization Name:SOUTH BAY SURGICAL AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-740-4933
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:562-728-0230
Mailing Address - Fax:562-728-0237
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:562-728-0230
Practice Address - Fax:562-728-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001865OtherCCN
CA05C0001865OtherCCN