Healthcare Provider Details

I. General information

NPI: 1114230364
Provider Name (Legal Business Name): PERSONS PLASTIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MORAGA RD. #205
LAFAYETTE CA
94549-4500
US

IV. Provider business mailing address

911 MORAGA RD. #205
LAFAYETTE CA
94549-4500
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-4012
  • Fax: 925-283-4847
Mailing address:
  • Phone: 925-283-4012
  • Fax: 925-283-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA64843
License Number StateCA

VIII. Authorized Official

Name: BARBARA LYNN PERSONS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-283-4012