Healthcare Provider Details

I. General information

NPI: 1104469105
Provider Name (Legal Business Name): TLC SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S LA CIENEGA BLVD # 210
BEVERLY HILLS CA
90211-3324
US

IV. Provider business mailing address

240 S LA CIENEGA BLVD # 210
BEVERLY HILLS CA
90211-3324
US

V. Phone/Fax

Practice location:
  • Phone: 310-882-5454
  • Fax: 310-882-5454
Mailing address:
  • Phone: 310-882-5454
  • Fax: 310-882-5454

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: DR. JAIME SCHWARTZ
Title or Position: OWNER
Credential: MD
Phone: 310-882-5454