Basic Information
| Provider Information | |||||||||
| NPI: | 1932560208 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED SURGICAL CENTER OF TORRANCE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASC OF TORRANCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 N BRAND BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912032644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22525 MAPLE AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905052700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2016 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | TCHAMANIAN | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8189379969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED SURGICAL CENTERS, INC | ||||||||
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| AuthorizedOfficialCredential: | CASC | ||||||||
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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.