Basic Information
| Provider Information | |||||||||
| NPI: | 1891333886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNSET TOWER SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 W SUNSET BLVD STE 405 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900693705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108871730 | ||||||||
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| Address1: | 9201 W SUNSET BLVD STE 405 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900693705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108871730 | ||||||||
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| ProviderEnumerationDate: | 12/20/2019 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | MATLOCK | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3104358864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.