Healthcare Provider Details

I. General information

NPI: 1336484096
Provider Name (Legal Business Name): HIGHLY ARTISTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 212 HIGHLY ARTISTIC SURGERY, INC
POWAY CA
92064-2060
US

IV. Provider business mailing address

15725 POMERADO RD STE 212 HIGHLY ARTISTIC SURGERY, INC
POWAY CA
92064-2060
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-3742
  • Fax: 858-206-3742
Mailing address:
  • Phone: 858-487-3742
  • Fax: 858-206-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA105747
License Number StateCA

VIII. Authorized Official

Name: DR. CHI D HA
Title or Position: CHAIR
Credential: M.D., FACS
Phone: 858-487-3742