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General NPI Number Information
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NPI Number | 1124430236
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Entity Type | Organization
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Legal Business Name | GROSSMAN PLASTIC SURGERY
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 7325 MEDICAL CENTER DR STE. 200
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City | WEST HILLS
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State | CA
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Zip | 91307-1925
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Country | US
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Telephone | 818-981-2050
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Fax | 818-981-2382
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Provider Business Mailing Address
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Address Line | 7325 MEDICAL CENTER DR STE. 200
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City | WEST HILLS
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State | CA
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Zip | 91307-1925
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Country | US
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Telephone | 818-981-2050
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Fax | 818-981-2382
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Authorized Official
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Title or Position | COO/CNO
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Name | MRS. KELLI RIX
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Credential | RN
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Telephone | 818-981-2050
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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 | G66484
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License Number State | CA
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