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General NPI Number Information
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NPI Number | 1477675841
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY CENTER LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 EL CAMINO REAL SUITE A
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City | PALO ALTO
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State | CA
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Zip | 94306-1052
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Country | US
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Telephone | 650-322-2723
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Fax | 650-322-3260
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Provider Business Mailing Address
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Address Line | 1515 EL CAMINO REAL SUITE A
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City | PALO ALTO
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State | CA
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Zip | 94306-1052
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Country | US
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Telephone | 650-322-2723
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Fax | 650-322-3260
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GEORGE COMMONS
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Credential | M.D.
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Telephone | 650-328-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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