Healthcare Provider Details

I. General information

NPI: 1326316217
Provider Name (Legal Business Name): WILLIAM BRUNO PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LASKY DR
BEVERLY HILLS CA
90212-3610
US

IV. Provider business mailing address

201 S LASKY DR
BEVERLY HILLS CA
90212-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-461-3855
  • Fax:
Mailing address:
  • Phone: 310-461-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA86713
License Number StateCA

VIII. Authorized Official

Name: MRS. MARTHA MACHADO
Title or Position: MANAGER
Credential:
Phone: 310-461-3855