Healthcare Provider Details

I. General information

NPI: 1700913902
Provider Name (Legal Business Name): FACESPLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 200
SAN DIEGO CA
92121-3023
US

IV. Provider business mailing address

4510 EXECUTIVE DR STE 200
SAN DIEGO CA
92121-3023
US

V. Phone/Fax

Practice location:
  • Phone: 858-842-2370
  • Fax: 858-842-2375
Mailing address:
  • Phone: 858-842-2370
  • Fax: 858-842-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R COHEN
Title or Position: OWNER
Credential: MD
Phone: 858-842-2370