Provider Demographics
NPI:1215941844
Name:SOUTH BAY PLASTIC SURGEONS, INC.
Entity type:Organization
Organization Name:SOUTH BAY PLASTIC SURGEONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-784-0644
Mailing Address - Street 1:3640 LOMITA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3904
Mailing Address - Country:US
Mailing Address - Phone:310-784-0644
Mailing Address - Fax:310-785-0544
Practice Address - Street 1:3640 LOMITA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3904
Practice Address - Country:US
Practice Address - Phone:310-784-0644
Practice Address - Fax:310-785-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty