Healthcare Provider Details

I. General information

NPI: 1447994116
Provider Name (Legal Business Name): HERMOSA SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PIER AVE STE 1
HERMOSA BEACH CA
90254-3800
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 424-488-0500
  • Fax: 424-488-0498
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

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. BAO NGUYEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-792-3914