Healthcare Provider Details

I. General information

NPI: 1124904974
Provider Name (Legal Business Name): SURGICAL INSTITUTE OF LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 3RD ST STE 905
LOS ANGELES CA
90013-1647
US

IV. Provider business mailing address

420 E 3RD ST STE 905
LOS ANGELES CA
90013-1647
US

V. Phone/Fax

Practice location:
  • Phone: 310-620-6030
  • Fax:
Mailing address:
  • Phone:
  • 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: SHERWIN BARVARZ
Title or Position: SOLE MEMBER/OWNER
Credential:
Phone: 310-620-6030