Healthcare Provider Details

I. General information

NPI: 1982965612
Provider Name (Legal Business Name): SKYPARK SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23441 MADISON ST STE 115
TORRANCE CA
90505-4725
US

IV. Provider business mailing address

23441 MADISON ST SUITE 115
TORRANCE CA
90505-4725
US

V. Phone/Fax

Practice location:
  • Phone: 424-247-2206
  • Fax: 213-617-0605
Mailing address:
  • Phone: 213-617-9194
  • Fax: 213-617-0605

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: DR. ALEX LIU
Title or Position: AO
Credential: M.D.
Phone: 213-625-2694