Healthcare Provider Details

I. General information

NPI: 1447476668
Provider Name (Legal Business Name): SBA OUTPATIENT SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LOMITA BOULEVARD SUITE 101
TORRANCE CA
90505-3900
US

IV. Provider business mailing address

371 VAN NESS WAY, SUITE 210
TORRANCE CA
90501-6297
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-6500
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-874-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER VERBIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-539-6500