Healthcare Provider Details

I. General information

NPI: 1851432256
Provider Name (Legal Business Name): AESTHETIC CENTER FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE SUITE 105
SANTA BARBARA CA
93111-2341
US

IV. Provider business mailing address

5333 HOLLISTER AVE SUITE 105
SANTA BARBARA CA
93111-2341
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-1359
  • Fax: 805-683-3319
Mailing address:
  • Phone: 805-967-1359
  • Fax: 805-683-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA32832
License Number StateCA

VIII. Authorized Official

Name: DR. JULIO A SOARES
Title or Position: DIRECTOR
Credential: M.D.
Phone: 805-967-1359