Healthcare Provider Details

I. General information

NPI: 1023531258
Provider Name (Legal Business Name): FACECENTERLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 ALMA REAL DR STE 204
PACIFIC PALISADES CA
90272-5020
US

IV. Provider business mailing address

881 ALMA REAL DR STE 204
PACIFIC PALISADES CA
90272-5020
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-5491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA BROSIUS
Title or Position: BILLING MANAGER
Credential:
Phone: 805-210-5491