Healthcare Provider Details

I. General information

NPI: 1548987332
Provider Name (Legal Business Name): CALIFORNIA SURGICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 400
BEVERLY HILLS CA
90210-4318
US

IV. Provider business mailing address

800A 5TH AVE STE 300A
NEW YORK NY
10065-7215
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-3982
  • Fax:
Mailing address:
  • Phone: 212-427-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN COATS
Title or Position: BILLING MANAGER
Credential:
Phone: 301-829-6396