Healthcare Provider Details

I. General information

NPI: 1538569207
Provider Name (Legal Business Name): CUTTING EDGE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD SUITE 130
TORRANCE CA
90505
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD SUITE 130
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-626-0550
  • Fax:
Mailing address:
  • Phone: 310-626-0550
  • Fax:

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: PETER BORDEN
Title or Position: CEO/OWNER
Credential: MD
Phone: 310-375-8700