Provider Demographics
NPI:1730378498
Name:TORRANCE CA MULTISPECIALTY ASC LLC
Entity type:Organization
Organization Name:TORRANCE CA MULTISPECIALTY ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:23500 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4702
Mailing Address - Country:US
Mailing Address - Phone:310-784-2710
Mailing Address - Fax:310-326-9137
Practice Address - Street 1:23500 MADISON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4702
Practice Address - Country:US
Practice Address - Phone:310-784-2710
Practice Address - Fax:310-326-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000223261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00724945OtherRAILROAD
CASUR01013GMedicaid
CAS051013BMedicare PIN
CAP00724945OtherRAILROAD