MEDICARE: L.A. REGIONAL SURGICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1376639278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.A. REGIONAL SURGICAL CENTER

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	#440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-471-5852
Fax Number	:	310-471-3958

Provider Business Practice Location Address
First Line	:	302 W LA VETA AVE
Second Line	:	#100
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-516-2600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ISAAC VERBUKH
Credential	:	M.D.
Telephone Number	:	714-516-2600

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

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