Healthcare Provider Details

I. General information

NPI: 1659624682
Provider Name (Legal Business Name): PLAYA ADVANCE SURGICAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 LINCOLN BLVD
LOS ANGELES CA
90094-2002
US

IV. Provider business mailing address

4712 ADMIRALTY WAY #930
MARINA DEL REY CA
90292-6905
US

V. Phone/Fax

Practice location:
  • Phone: 310-600-5846
  • Fax:
Mailing address:
  • Phone: 310-600-5846
  • 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: MS. GLADYS ANNE HAPPER
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 310-600-5846