Healthcare Provider Details

I. General information

NPI: 1427482173
Provider Name (Legal Business Name): BEVERLY HILLS LASKY SURGICENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S LASKY DR
BEVERLY HILLS CA
90212-1704
US

IV. Provider business mailing address

160 S LASKY DR
BEVERLY HILLS CA
90212-1704
US

V. Phone/Fax

Practice location:
  • Phone: 310-566-5663
  • Fax:
Mailing address:
  • Phone: 310-566-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. THOMAS C CLOUD III
Title or Position: CHAIRMAN CREDENTIALING COMMITTE
Credential: MPH
Phone: 323-301-2178