=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336359322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PLASTIC SURGERY CENTER, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 03/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15503 VENTURA BLVD STE 370
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-907-9090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15503 VENTURA BLVD STE 370
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-907-9090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN VARKONY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-907-9090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | A50335
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------