Provider Demographics
NPI:1891377339
Name:AIRPORT URGENT CARE SURGERY CENTER
Entity Type:Organization
Organization Name:AIRPORT URGENT CARE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-403-7809
Mailing Address - Street 1:PO BOX 11147
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-7147
Mailing Address - Country:US
Mailing Address - Phone:310-299-5404
Mailing Address - Fax:310-602-6287
Practice Address - Street 1:1117 W MANCHESTER BLVD STE M
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1596
Practice Address - Country:US
Practice Address - Phone:310-299-5404
Practice Address - Fax:310-602-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical