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General NPI Number Information
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NPI Number | 1538174206
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Entity Type | Organization
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Legal Business Name | BELLA MIA PLASTIC AND RECONSTRUCTIVE SURGERY CENTER, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 1169 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220
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Country | US
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Telephone | 951-925-8876
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Fax | 951-925-3575
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Provider Business Mailing Address
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Address Line | 1169 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-4443
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Country | US
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Telephone | 951-925-8876
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Fax | 951-925-3575
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIA LEE
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Credential | M.D.
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Telephone | 951-925-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A85329
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License Number State | CA
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