Healthcare Provider Details

I. General information

NPI: 1922613207
Provider Name (Legal Business Name): RESURGENT HEAD AND NECK SURGEONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 10/04/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 MAGNOLIA AVE STE 220
RIVERSIDE CA
92506-2858
US

IV. Provider business mailing address

PO BOX 7270
MORENO VALLEY CA
92552-7270
US

V. Phone/Fax

Practice location:
  • Phone: 951-656-1500
  • Fax: 951-656-1510
Mailing address:
  • Phone: 951-656-1500
  • Fax: 951-656-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL GABARAIN
Title or Position: CEO
Credential: MD
Phone: 951-981-2200