Healthcare Provider Details

I. General information

NPI: 1124430236
Provider Name (Legal Business Name): GROSSMAN PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 MEDICAL CENTER DR STE. 200
WEST HILLS CA
91307-1925
US

IV. Provider business mailing address

7325 MEDICAL CENTER DR STE. 200
WEST HILLS CA
91307-1925
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-2050
  • Fax: 818-981-2382
Mailing address:
  • Phone: 818-981-2050
  • Fax: 818-981-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG66484
License Number StateCA

VIII. Authorized Official

Name: MRS. KELLI RIX
Title or Position: COO/CNO
Credential: RN
Phone: 818-981-2050