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General NPI Number Information
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NPI Number | 1659624682
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Entity Type | Organization
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Legal Business Name | PLAYA ADVANCE SURGICAL INSTITUTE LLC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 5450 LINCOLN BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90094-2002
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Country | US
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Telephone | 310-600-5846
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Fax |
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Provider Business Mailing Address
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Address Line | 4712 ADMIRALTY WAY #930
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 310-600-5846
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. GLADYS ANNE HAPPER
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Credential | NP
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Telephone | 310-600-5846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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