=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497483416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKEWOOD SURGICAL SPECIALISTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2022
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3510 E SOUTH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-9071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-602-5594
-----------------------------------------------------
Fax | 562-808-2145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3510 E SOUTH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-602-5594
-----------------------------------------------------
Fax | 562-808-2145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MISS CHELSEA BARCENAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-310-6309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------