Healthcare Provider Details

I. General information

NPI: 1336497353
Provider Name (Legal Business Name): TANSAVATDI COSMETIC & RECONSTRUCTIVE SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 TOWNSGATE RD STE 101
WESTLAKE VILLAGE CA
91361-3005
US

IV. Provider business mailing address

2835 TOWNSGATE RD STE 100
WESTLAKE VILLAGE CA
91361-5021
US

V. Phone/Fax

Practice location:
  • Phone: 805-715-4996
  • Fax: 805-715-4995
Mailing address:
  • Phone: 805-715-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA116470
License Number StateCA

VIII. Authorized Official

Name: DR. KRISTINA TANSAVATDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-715-4996