MEDICARE: COSMETIC SURGERY CLINICS

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	A85870A	CA

General Provider Information

NPI Number	:	1982615902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMETIC SURGERY CLINICS

Provider Business Mailing Address
First Line	:	32406 COAST HWY STE 1
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6783
Country	:	US
Telephone Number	:	949-499-4147
Fax Number	:	949-499-2585

Provider Business Practice Location Address
First Line	:	32406 COAST HWY STE 1
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6783
Country	:	US
Telephone Number	:	949-499-4147
Fax Number	:	949-499-2585

Authorized Official
Title or Position	:	CEO
Name	:	ARIAN S MOWLAVI
Credential	:	M.D.
Telephone Number	:	949-499-4147

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/11/2018

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