Healthcare Provider Details

I. General information

NPI: 1053391169
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF THE SOUTH BAY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST SUITE 109
TORRANCE CA
90505-4709
US

IV. Provider business mailing address

23560 MADISON ST SUITE 109
TORRANCE CA
90505-4709
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-6331
  • Fax: 310-325-6335
Mailing address:
  • Phone: 310-325-6331
  • Fax: 310-325-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number930000465
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283