Healthcare Provider Details

I. General information

NPI: 1619048261
Provider Name (Legal Business Name): WILLIAM STEVEN UMANSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM S UMANSKY M.D.

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW 260
LA JOLLA CA
92037
US

IV. Provider business mailing address

4150 REGENTS PARK ROW 260
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-550-9697
  • Fax: 858-550-9698
Mailing address:
  • Phone: 858-550-9697
  • Fax: 858-550-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG067858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: