Healthcare Provider Details

I. General information

NPI: 1215941844
Provider Name (Legal Business Name): SOUTH BAY PLASTIC SURGEONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 LOMITA BLVD STE 306
TORRANCE CA
90505-3904
US

IV. Provider business mailing address

3640 LOMITA BLVD STE 306
TORRANCE CA
90505-3904
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-0644
  • Fax: 310-785-0544
Mailing address:
  • Phone: 310-784-0644
  • Fax: 310-785-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY ALEXIS BURRELL
Title or Position: SECRETARY
Credential: MD
Phone: 310-784-0644