Healthcare Provider Details

I. General information

NPI: 1134354533
Provider Name (Legal Business Name): HARBOR PLASTIC SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 CANTERWOOD BLVD NW SUITE 310
GIG HARBOR WA
98332-5813
US

IV. Provider business mailing address

11511 CANTERWOOD BLVD NW SUITE 310
GIG HARBOR WA
98332-5813
US

V. Phone/Fax

Practice location:
  • Phone: 253-858-5040
  • Fax: 888-843-2412
Mailing address:
  • Phone: 253-858-5040
  • Fax: 888-843-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD00049097
License Number StateWA

VIII. Authorized Official

Name: DR. JUSTIN HOWARD PIASECKI
Title or Position: MEMBER
Credential: M.D.
Phone: 253-509-4438