Organization
LAX SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMSON YIRGU (ADMINISTRATOR)
(323) 500-7809
Entity
Organization
Contact information
Practice address
5450 LINCOLN BLVD # 100, PLAYA VISTA, CA 90094-2002
(310) 305-9200
Mailing address
4712 ADMIRALTY WAY # 574, MARINA DEL REY, CA 90292-6905
(310) 305-9200
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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