Healthcare Provider Details

I. General information

NPI: 1912450065
Provider Name (Legal Business Name): SOCAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N ROBERTSON BLVD
BEVERLY HILLS CA
90211-2103
US

IV. Provider business mailing address

11870 SANTA MONICA BLVD STE 106-549
LOS ANGELES CA
90025-2276
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-7329
  • Fax: 310-388-1771
Mailing address:
  • Phone: 310-435-7329
  • Fax: 310-388-1771

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: ROBERT E SCHLENKER
Title or Position: OWNER
Credential: MD
Phone: 310-435-7329