Healthcare Provider Details

I. General information

NPI: 1841013992
Provider Name (Legal Business Name): ARCADIA LIVE OAK SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W LIVE OAK AVE
ARCADIA CA
91007-8561
US

IV. Provider business mailing address

80 W LIVE OAK AVE
ARCADIA CA
91007-8561
US

V. Phone/Fax

Practice location:
  • Phone: 626-461-5408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD PORTOCARRERO
Title or Position: CEO
Credential: DO
Phone: 626-461-5408