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General NPI Number Information
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NPI Number | 1598148942
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Entity Type | Organization
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Legal Business Name | WALTZMAN PLASTIC AND RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 4251 LONG BEACH BLVD. 102
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City | LONG BEACH
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State | CA
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Zip | 90807
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Country | US
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Telephone | 562-448-6100
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Fax | 562-448-6101
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Provider Business Mailing Address
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Address Line | 4251 LONG BEACH BLVD. 102
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City | LONG BEACH
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State | CA
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Zip | 90807
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Country | US
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Telephone | 562-448-6100
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Fax | 562-448-6101
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOSHUA T WALTZMAN
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Credential | M.D.
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Telephone | 562-448-6100
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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 | A128713
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License Number State | CA
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