Healthcare Provider Details

I. General information

NPI: 1932224664
Provider Name (Legal Business Name): PICKART PLASTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 LOMA VISTA ROAD
VENTURA CA
93003
US

IV. Provider business mailing address

3438 LOMA VISTA ROAD
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-654-8800
  • Fax: 805-654-8802
Mailing address:
  • Phone: 805-654-8800
  • Fax: 805-654-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MICHAEL C. PICKART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-654-1460