Healthcare Provider Details

I. General information

NPI: 1598148942
Provider Name (Legal Business Name): WALTZMAN PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 11/16/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 LONG BEACH BLVD. 102
LONG BEACH CA
90807
US

IV. Provider business mailing address

4251 LONG BEACH BLVD. 102
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-448-6100
  • Fax: 562-448-6101
Mailing address:
  • Phone: 562-448-6100
  • Fax: 562-448-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA128713
License Number StateCA

VIII. Authorized Official

Name: DR. JOSHUA T WALTZMAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 562-448-6100