=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598296410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORRANCE HEALTH ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2017
-----------------------------------------------------
Last Update Date | 08/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23560 CRENSHAW BLVD SUITE 102
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-784-2355
-----------------------------------------------------
Fax | 310-517-1817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23326 HAWTHORNE BLVD SUITE 200
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-257-7205
-----------------------------------------------------
Fax | 310-598-3117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VICE PRESIDENT
-----------------------------------------------------
Name | SALLY EBERHARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-325-9110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------