Healthcare Provider Details

I. General information

NPI: 1053913129
Provider Name (Legal Business Name): CENTER FOR COSMETIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HERITAGE RD STE 100
GOLDEN CO
80401-3673
US

IV. Provider business mailing address

725 HERITAGE RD STE 100
GOLDEN CO
80401-3673
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-2600
  • Fax:
Mailing address:
  • Phone: 303-278-2600
  • Fax:

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: QUDDUS SILVA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 303-278-2600