Healthcare Provider Details

I. General information

NPI: 1609049634
Provider Name (Legal Business Name): CONTOURED IMAGES PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 411
LONG BEACH CA
90806-2789
US

IV. Provider business mailing address

701 E 28TH ST STE 411
LONG BEACH CA
90806-2789
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-1322
  • Fax: 562-427-4282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG74521
License Number StateCA

VIII. Authorized Official

Name: DEBRA STAFFORD
Title or Position: OWNER
Credential:
Phone: 562-427-1322