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General NPI Number Information
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NPI Number | 1578487195
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Entity Type | Organization
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Legal Business Name | SELECT PLASTIC SURGERY
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 3617 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5601
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Country | US
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Telephone | 213-935-8577
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Fax |
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Provider Business Mailing Address
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Address Line | 3617 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | JENNIFER HERTZ
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Credential | MD
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Telephone | 323-445-6249
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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 |
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License Number State |
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