Healthcare Provider Details

I. General information

NPI: 1306937081
Provider Name (Legal Business Name): RECONSTRUCTIVE SURGERY AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY STE 240
TORRANCE CA
90505-6658
US

IV. Provider business mailing address

3445 PACIFIC COAST HWY STE 240
TORRANCE CA
90505-6658
US

V. Phone/Fax

Practice location:
  • Phone: 310-891-0000
  • Fax: 310-891-0367
Mailing address:
  • Phone: 310-891-0000
  • Fax: 310-891-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG36859
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE SAKS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 310-891-0000