Provider Demographics
NPI:1962032748
Name:INCINTA SURGERY CENTER
Entity Type:Organization
Organization Name:INCINTA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-408-0479
Mailing Address - Street 1:21545 HAWTHORNE BLVD
Mailing Address - Street 2:PAVILION B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:424-212-4087
Mailing Address - Fax:424-212-4088
Practice Address - Street 1:21545 HAWTHORNE BLVD
Practice Address - Street 2:PAVILION B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:424-212-4087
Practice Address - Fax:424-212-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility