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General NPI Number Information
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NPI Number | 1801055678
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Entity Type | Organization
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Legal Business Name | IE SURGICAL, INC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 8631 W 3RD ST STE 945E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5912
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Country | US
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Telephone | 310-657-0871
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Fax | 310-657-0142
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Provider Business Mailing Address
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Address Line | PO BOX 451400
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City | WESTCHESTER
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State | CA
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Zip | 90045-8515
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Country | US
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Telephone | 310-657-0871
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Fax | 310-657-0142
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN F OSBORNE
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Credential | M.D.
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Telephone | 310-657-0871
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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 | 002172882-0001-6
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License Number State | CA
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