Provider Demographics
NPI:1932324126
Name:SEA-PARK MEDICAL GROUP
Entity Type:Organization
Organization Name:SEA-PARK MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOLBRITT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-325-3338
Mailing Address - Street 1:3525 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6655
Mailing Address - Country:US
Mailing Address - Phone:310-325-3338
Mailing Address - Fax:310-325-3499
Practice Address - Street 1:3525 PACIFIC COAST HWY
Practice Address - Street 2:SUITE C
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6655
Practice Address - Country:US
Practice Address - Phone:310-325-3338
Practice Address - Fax:310-325-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center