Provider Demographics
NPI:1952492860
Name:ASSOCIATION OF SOUTH BAY SURGEONS
Entity Type:Organization
Organization Name:ASSOCIATION OF SOUTH BAY SURGEONS
Other - Org Name:SOUTH COAST SURGICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-373-6864
Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-373-6864
Mailing Address - Fax:310-373-6065
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-373-6864
Practice Address - Fax:310-373-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11216Medicare ID - Type UnspecifiedMEDICARE GROUP ID #