MEDICARE: CENTER FOR MULTISPECIALTY AESTHETIC & RECONSTRUCTIVE SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1760841134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR MULTISPECIALTY AESTHETIC & RECONSTRUCTIVE SURGERY

Provider Business Mailing Address
First Line	:	9401 WILSHIRE BLVD
Second Line	:	650
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2913
Country	:	US
Telephone Number	:	631-827-8159
Fax Number	:	631-368-1538

Provider Business Practice Location Address
First Line	:	9401 WILSHIRE BLVD
Second Line	:	650
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2913
Country	:	US
Telephone Number	:	631-827-8159
Fax Number	:	631-368-1538

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MATHEW JAMES
Credential	:
Telephone Number	:	631-827-8159

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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