Basic Information
| Provider Information | |||||||||
| NPI: | 1902858012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH PENINSULA SURGICAL CENTER LP | ||||||||
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| OtherOrganizationName: | TORRANCE OUTPATIENT SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 N. BRAND BLVD, STE 303 | ||||||||
| Address2: | PRIME MSO/NORTH PENINSULA SURGICAL CENTER | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
| FaxNumber: | 8189379968 | ||||||||
| Practice Location | |||||||||
| Address1: | 22525 MAPLE AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905052700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106025480 | ||||||||
| FaxNumber: | 8582250292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | TCHAMANIAN | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 8189379969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.