Provider Demographics
NPI:1336143734
Name:TORRANCE ENDOSCOPY AND SURGICAL AFFILIATES, INC
Entity Type:Organization
Organization Name:TORRANCE ENDOSCOPY AND SURGICAL AFFILIATES, INC
Other - Org Name:ENDOSCOPY CENTER AT SKYPARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-375-1246
Mailing Address - Street 1:23441 MADISON ST
Mailing Address - Street 2:STE 230
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4757
Mailing Address - Country:US
Mailing Address - Phone:310-375-6461
Mailing Address - Fax:310-375-7201
Practice Address - Street 1:23441 MADISON ST
Practice Address - Street 2:STE 230
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4757
Practice Address - Country:US
Practice Address - Phone:310-375-6461
Practice Address - Fax:310-375-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01559FMedicaid
CAS051559Medicare ID - Type Unspecified