Northwest Surgical Development of Marina del Rey, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

NORTHWEST SURGICAL DEVELOPMENT OF MARINA DEL REY, LLC

Practice address

4560 Admiralty Way Ste 256
Marina del Rey, CA 90292-5444

Phone

(310) 827-2653

Fax

(310) 827-1493

NPI assigned

Jun 20, 2024

Last updated

Jun 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Martinez

Title

Assistant Manager

Phone

(310) 827-2653

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1548004971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 ADMIRALTY WAY STE 256",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925444",
            "telephone_number": "310-827-2653",
            "fax_number": "310-827-1493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 ADMIRALTY WAY STE 256",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925444",
            "telephone_number": "310-827-2653",
            "fax_number": "310-827-1493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SURGICAL DEVELOPMENT OF MARINA DEL REY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "310-827-2653"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Noble, DO
• Nami Mia Nocifera, LCSW
• Brittany Lynn Nolan, PA-C
• Shana Ryan Nordyke, NP
• Joshua Norman, RPH
• Adrian Nunez
• Brandon O'Malley, PMHNP-BC
• Geoffery Alan O'Neill, M.D.
• Holly O'Rourke, CRNA
• Oband, Inc

• Plastic Surgery Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.