=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629254230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESTHETIC PLASTIC SURGICAL INSTITUTE, A MED. CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2008
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31852 PACIFIC COAST HIGHWAY SUITE #401
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-6764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-499-2800
-----------------------------------------------------
Fax | 949-499-9590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31852 PACIFIC COAST HIGHWAY SUITE #401
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-6764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-499-2800
-----------------------------------------------------
Fax | 949-499-9590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL C MILLS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-499-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | G56260
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------