Provider Demographics
NPI:1073056537
Name:UROLOGIC SURGEONS OF THE SOUTH BAY
Entity Type:Organization
Organization Name:UROLOGIC SURGEONS OF THE SOUTH BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-534-8400
Mailing Address - Street 1:23600 TELO AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4039
Mailing Address - Country:US
Mailing Address - Phone:310-534-8400
Mailing Address - Fax:310-534-0463
Practice Address - Street 1:23600 TELO AVE STE 220
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4039
Practice Address - Country:US
Practice Address - Phone:310-534-8400
Practice Address - Fax:310-534-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48982174400000X
CAA75707174400000X
CAA103673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty