Healthcare Provider Details

I. General information

NPI: 1578487195
Provider Name (Legal Business Name): SELECT PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 AVALON BLVD
LOS ANGELES CA
90011-5601
US

IV. Provider business mailing address

3617 AVALON BLVD
LOS ANGELES CA
90011-5601
US

V. Phone/Fax

Practice location:
  • Phone: 213-935-8577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HERTZ
Title or Position: OWNDER
Credential: MD
Phone: 323-445-6249