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General NPI Number Information
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NPI Number | 1053490755
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Entity Type | Organization
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Legal Business Name | CENTURY CITY SURGICAL ASSOCIATES A MEDICAL CORPORATION ASSOCIATES MEDI
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 6076 BRISTOL PKWY STE 108
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City | CULVER CITY
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State | CA
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Zip | 90230-6600
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Country | US
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Telephone | 310-348-9604
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Fax | 310-338-1219
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Provider Business Mailing Address
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Address Line | PO BOX 3098
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City | TORRANCE
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State | CA
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Zip | 90510-3098
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | SPENCER LELAND BROWN
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Credential | MD
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Telephone | 310-348-9604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G46653
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License Number State | CA
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