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General NPI Number Information
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NPI Number | 1528129194
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Entity Type | Organization
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Legal Business Name | CONGRESS COSMETIC MEDICAL CORP
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 10 CONGRESS ST SUITE # 320
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City | PASADENA
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State | CA
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Zip | 91105-3023
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Country | US
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Telephone | 626-585-9474
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Fax | 626-585-9480
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Provider Business Mailing Address
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Address Line | 10 CONGRESS ST SUITE # 320
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City | PASADENA
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State | CA
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Zip | 91105-3023
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Country | US
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Telephone | 626-585-9474
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Fax | 626-585-9480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARILYN ANN MEHLMAUER
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Credential | MD
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Telephone | 626-585-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | GO35270
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License Number State | CA
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