| Organization Name: | PLASTIC AND RECONSTRUCTIVE SURGERY |
| NPI Number: | 1043249972 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUDI HICKLIN (ADMINISTRATOR) |
| Mailing Address: | 1387 Santa Rita Rd Pleasanton |
| State: | CA US |
| Postal Code: | 945665643 |
| Phone Number: | 9254623700 |
| Fax Number: | 9254624681 |
| NPI Enumeration Date: | 07/02/2006 |
| NPI Last Update Date: | 05/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 140000491 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |