Healthcare Provider Details

I. General information

NPI: 1083767891
Provider Name (Legal Business Name): MADISON PARK SURGERY & LASER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY SUITE 250
TORRANCE CA
90505-6658
US

IV. Provider business mailing address

3445 PACIFIC COAST HWY SUITE 250
TORRANCE CA
90505-6658
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-2900
  • Fax: 310-891-0367
Mailing address:
  • Phone: 310-530-2900
  • Fax: 310-891-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAWRENCE SAKS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 310-530-2900