Healthcare Provider Details

I. General information

NPI: 1437984838
Provider Name (Legal Business Name): HIGHTOWER SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 405
LOS ANGELES CA
90069-3705
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 405
LOS ANGELES CA
90069-3705
US

V. Phone/Fax

Practice location:
  • Phone: 310-887-1730
  • Fax: 310-887-1733
Mailing address:
  • Phone: 310-887-1730
  • Fax: 310-887-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LOUIS MATLOCK
Title or Position: CEO/MEDICAL DDOIRECTOR
Credential: MD, MBA
Phone: 310-877-1733