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General NPI Number Information
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NPI Number | 1508651068
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Entity Type | Organization
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Legal Business Name | PLASTIC REJUVENATION MEDICAL PROFESSIONAL/CORP
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 25408 CRENSHAW BLVD
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City | TORRANCE
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State | CA
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Zip | 90505
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Country | US
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Telephone | 818-518-5980
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N MOUNTAIN AVE SUITE B100
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 818-518-5980
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Fax | 818-337-2069
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DENNIS ALWEN
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Credential | MD
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Telephone | 818-518-5980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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