Healthcare Provider Details

I. General information

NPI: 1215489711
Provider Name (Legal Business Name): SURGICAL AND PAIN MANAGEMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD SUITE 106
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD SUITE 106
BEVERLY HILLS CA
90211-2222
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-4979
  • Fax:
Mailing address:
  • Phone: 310-409-4979
  • 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: DR. OSCAR LEAL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-409-4979