| Organization Name: | CENTRAL COAST FACIAL SURGERY CENTER |
| NPI Number: | 1083671358 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROMAN P BUKACHEVSKY (MEMBER-MANAGER) |
| Mailing Address: | 295 Posada Ln Suite B Templeton |
| State: | CA US |
| Postal Code: | 934654055 |
| Phone Number: | 8054345960 |
| Fax Number: | 8054345963 |
| NPI Enumeration Date: | 04/28/2006 |
| NPI Last Update Date: | 08/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | FNP26330 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |