Healthcare Provider Details

I. General information

NPI: 1982066536
Provider Name (Legal Business Name): LA JOLLA CENTER FOR FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT SUITE 206
LA JOLLA CA
92037-0027
US

IV. Provider business mailing address

3252 HOLIDAY CT SUITE 206
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-658-0595
  • Fax: 858-658-0596
Mailing address:
  • Phone: 858-658-0595
  • Fax: 858-658-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROY A DAVID
Title or Position: OWNER
Credential: MD
Phone: 858-658-0595