Provider Demographics
NPI:1184805590
Name:BEACH SURGICAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:BEACH SURGICAL MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-539-2279
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-1403
Mailing Address - Country:US
Mailing Address - Phone:714-375-3779
Mailing Address - Fax:714-375-3889
Practice Address - Street 1:18080 BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1342
Practice Address - Country:US
Practice Address - Phone:714-375-3779
Practice Address - Fax:714-375-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA255480261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty