Healthcare Provider Details

I. General information

NPI: 1942124631
Provider Name (Legal Business Name): INDEPENDENT SURGEONS OF AMERICA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 MINDANAO WAY SUITE 300
MARINA DEL REY CA
90292
US

IV. Provider business mailing address

13160 MINDANAO WAY SUITE 300
MARINA DEL REY CA
90292
US

V. Phone/Fax

Practice location:
  • Phone: 310-437-7921
  • Fax:
Mailing address:
  • Phone: 310-920-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD GLIMP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-480-8852