Healthcare Provider Details

I. General information

NPI: 1881992550
Provider Name (Legal Business Name): CONTEMPORARY PLASTIC SURGERY MEDICAL GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 SAN RAMON VALLEY BLVD 288
DANVILLE CA
94526-4031
US

IV. Provider business mailing address

913 SAN RAMON VALLEY BLVD 288
DANVILLE CA
94526-4031
US

V. Phone/Fax

Practice location:
  • Phone: 925-820-3633
  • Fax: 925-820-3655
Mailing address:
  • Phone: 925-820-3633
  • Fax: 925-820-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG36751
License Number StateCA

VIII. Authorized Official

Name: ELLIOTT BRUCE LAVEY
Title or Position: PRESIDENT
Credential: MD
Phone: 925-820-3633