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General NPI Number Information
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NPI Number | 1124074059
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Entity Type | Organization
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Legal Business Name | BLUE PACIFIC AESTHETIC MEDICAL GROUP
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 415 PIER AVE
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-3820
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Country | US
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Telephone | 310-379-6074
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 800-883-7243
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Fax | 714-647-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS ROY MEST
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Credential | M.D.
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Telephone | 714-347-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | FNP27928
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License Number State | CA
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