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General NPI Number Information
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NPI Number | 1194593004
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Entity Type | Organization
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Legal Business Name | BURBANK PLASTIC SURGERY ASSOCIATES INC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 181 S BUENA VISTA ST FL 3
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City | BURBANK
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State | CA
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Zip | 91505-4504
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Country | US
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Telephone | 818-748-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 1385 MILLER DR
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City | LOS ANGELES
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State | CA
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Zip | 90069-1419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | STEVUNI HARRISON
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Credential |
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Telephone | 909-710-2020
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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 |
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License Number State |
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