Healthcare Provider Details

I. General information

NPI: 1306245386
Provider Name (Legal Business Name): BURBANK PLASTIC SURGERY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W ALAMEDA AVE
BURBANK CA
91506
US

IV. Provider business mailing address

2301 W ALAMEDA AVE
BURBANK CA
91506
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-0590
  • Fax: 818-848-3574
Mailing address:
  • Phone: 818-848-0590
  • Fax: 818-848-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BLANKA ORLOFF
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-848-0590