Healthcare Provider Details

I. General information

NPI: 1538004171
Provider Name (Legal Business Name): MOSTOVYCH FACIAL PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 NW LABICHE LN STE 130
BEND OR
97703-6748
US

IV. Provider business mailing address

2220 NW LABICHE LN STE 130
BEND OR
97703-6748
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-2026
  • Fax:
Mailing address:
  • Phone: 541-728-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NADIA MOSTOVYCH
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 240-751-3172