Healthcare Provider Details

I. General information

NPI: 1366831174
Provider Name (Legal Business Name): PACIFIC CENTER FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 MACARTHUR BLVD SUITE 320
NEWPORT BEACH CA
92660-3009
US

IV. Provider business mailing address

3991 MACARTHUR BLVD SUITE 320
NEWPORT BEACH CA
92660-3009
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-3888
  • Fax: 714-902-1101
Mailing address:
  • Phone: 949-720-3888
  • Fax: 714-902-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY STEVEN NICHTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-720-3888