Healthcare Provider Details

I. General information

NPI: 1194593004
Provider Name (Legal Business Name): BURBANK PLASTIC SURGERY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST FL 3
BURBANK CA
91505-4504
US

IV. Provider business mailing address

1385 MILLER DR
LOS ANGELES CA
90069-1419
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-4930
  • Fax:
Mailing address:
  • Phone:
  • 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: STEVUNI HARRISON
Title or Position: CREDENTIALING
Credential:
Phone: 909-710-2020