Provider Demographics
NPI:1649045493
Name:LASKY DRIVE SURGERY CENTER
Entity type:Organization
Organization Name:LASKY DRIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAD
Authorized Official - Middle Name:RADY
Authorized Official - Last Name:RAHBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-550-9858
Mailing Address - Street 1:152 S LASKY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1715
Mailing Address - Country:US
Mailing Address - Phone:310-550-9858
Mailing Address - Fax:
Practice Address - Street 1:152 S LASKY DR STE 102
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1715
Practice Address - Country:US
Practice Address - Phone:310-550-9858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty