Healthcare Provider Details

I. General information

NPI: 1932613601
Provider Name (Legal Business Name): OCULOFACIAL SURGICAL ARTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 POINTE DEL MAR WAY STE 100
DEL MAR CA
92014-3862
US

IV. Provider business mailing address

8650 GENESEE AVE UNIT 928725
SAN DIEGO CA
92192-6071
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-4322
  • Fax:
Mailing address:
  • Phone: 858-598-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN-PAUL ABBOUD
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 858-356-2647