=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306937081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECONSTRUCTIVE SURGERY AFFILIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3445 PACIFIC COAST HWY STE 240
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-6658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-891-0000
-----------------------------------------------------
Fax | 310-891-0367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 PACIFIC COAST HWY STE 240
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-6658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-891-0000
-----------------------------------------------------
Fax | 310-891-0367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | LAWRENCE SAKS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-891-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G36859
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------