Organization Name: | PLASTIC SURGERY GROUP, A MEDICAL CORPORATION |
NPI Number: | 1689097883 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEVON NICCOLE (CEO) |
Mailing Address: | 1101 Bayside Dr Suite 100 Corona Del Mar |
State: | CA US |
Postal Code: | 926251702 |
Phone Number: | 9497186900 |
Fax Number: | |
NPI Enumeration Date: | 01/24/2014 |
NPI Last Update Date: | 01/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A30397 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |