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General NPI Number Information
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NPI Number | 1598090052
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Entity Type | Organization
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Legal Business Name | LARRY S NICHTER MD & JED H HOROWITZ MD
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 3991 MACARTHUR BLVD SUITE 320
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3009
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Country | US
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Telephone | 949-720-3888
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Fax | 714-902-1101
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Provider Business Mailing Address
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Address Line | 3991 MACARTHUR BLVD SUITE 320
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3009
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Country | US
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Telephone | 949-720-3888
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Fax | 714-902-1101
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LARRY S NICHTER
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Credential | MD
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Telephone | 714-902-1100
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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 | G55515
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License Number State | CA
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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 | G39915
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License Number State | CA
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