Provider Demographics
NPI:1841237831
Name:LOS ANGELES SURGICAL CENTER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LOS ANGELES SURGICAL CENTER A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ACCOUNTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:GARCIA BACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-637-2530
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-1062
Mailing Address - Country:US
Mailing Address - Phone:213-637-2530
Mailing Address - Fax:213-384-3373
Practice Address - Street 1:2200 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4002
Practice Address - Country:US
Practice Address - Phone:213-637-2539
Practice Address - Fax:213-384-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01409FMedicaid
CASUR01409FMedicaid