| Organization Name: | NORTHRIDGE FACIAL PLASTIC SURGERY MEDICAL GROUP |
| NPI Number: | 1003824434 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARC M KERNER (MEDICAL DIRECTOR) |
| Mailing Address: | 18350 Roscoe Blvd #318a Northridge |
| State: | CA US |
| Postal Code: | 913254109 |
| Phone Number: | 8189939824 |
| Fax Number: | 8189930937 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 01/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | S051366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |