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General NPI Number Information
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NPI Number | 1114230364
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Entity Type | Organization
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Legal Business Name | PERSONS PLASTIC SURGERY, INC.
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 911 MORAGA RD. #205
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City | LAFAYETTE
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State | CA
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Zip | 94549-4500
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Country | US
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Telephone | 925-283-4012
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Fax | 925-283-4847
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Provider Business Mailing Address
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Address Line | 911 MORAGA RD. #205
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City | LAFAYETTE
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State | CA
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Zip | 94549-4500
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Country | US
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Telephone | 925-283-4012
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Fax | 925-283-4847
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA LYNN PERSONS
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Credential | M.D.
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Telephone | 925-283-4012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A64843
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License Number State | CA
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