Provider Demographics
NPI:1871838953
Name:DOCTORS AND SURGEONS OF LOS ANGELES
Entity type:Organization
Organization Name:DOCTORS AND SURGEONS OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:714-282-2222
Mailing Address - Street 1:3425 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3029
Mailing Address - Country:US
Mailing Address - Phone:323-567-2637
Mailing Address - Fax:714-644-8439
Practice Address - Street 1:3425 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3029
Practice Address - Country:US
Practice Address - Phone:323-567-2637
Practice Address - Fax:714-644-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA016332261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical