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General NPI Number Information
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NPI Number | 1467607127
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Entity Type | Organization
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Legal Business Name | TRILLIUM MED SPA COSMETIC SURGERY AND LASER CENTER
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Dates
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Enumeration Date | 11/22/2008
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 145 PARK LN STE 200
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City | MOORPARK
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State | CA
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Zip | 93021-2117
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Country | US
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Telephone | 805-531-9419
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Fax | 805-531-9494
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Provider Business Mailing Address
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Address Line | 145 PARK LN STE 200
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City | MOORPARK
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State | CA
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Zip | 93021-2117
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Country | US
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Telephone | 805-531-9419
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Fax | 805-531-9494
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Authorized Official
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Title or Position | OWNER
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Name | TROY CHRISTOPHER WILLIAMS
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Credential |
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Telephone | 818-597-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A103922
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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