Healthcare Provider Details

I. General information

NPI: 1275532889
Provider Name (Legal Business Name): COAST SURGERY CENTER L P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY STE 110
TORRANCE CA
90505-6658
US

IV. Provider business mailing address

3445 PACIFIC COAST HWY STE 110
TORRANCE CA
90505-6658
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-4555
  • Fax: 310-325-5005
Mailing address:
  • Phone: 310-325-4555
  • Fax: 310-325-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberCLN794
License Number StateCA

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER, AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269