| Organization Name: | MODERN INTITUTE OF PLASTIC SURGERY & ANTI-AGING |
| NPI Number: | 1003090978 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN A. STANTON (MEDICAL DIRECTOR) |
| Mailing Address: | 9090 Burton Way Beverly Hills |
| State: | CA US |
| Postal Code: | 902111661 |
| Phone Number: | 3102780077 |
| Fax Number: | |
| NPI Enumeration Date: | 12/27/2007 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | C2780128 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |