Healthcare Provider Details

I. General information

NPI: 1336319441
Provider Name (Legal Business Name): PREMIERE PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S ARROYO PKWY STE 310
PASADENA CA
91105-3930
US

IV. Provider business mailing address

950 S ARROYO PKWY STE 310
PASADENA CA
91105-3930
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4859
  • Fax: 626-403-0311
Mailing address:
  • Phone: 626-449-4859
  • Fax: 626-403-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN A. COX
Title or Position: CEO
Credential: MD
Phone: 626-449-4859