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General NPI Number Information
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NPI Number | 1659092906
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Entity Type | Organization
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Legal Business Name | LCW PRS
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 5295 TOWN CENTER RD STE 402
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City | BOCA RATON
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State | FL
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Zip | 33486-1080
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Country | US
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Telephone | 215-206-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 NW 26TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33434-3664
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Country | US
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Telephone | 215-206-9705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIZA WU
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Credential | MD
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Telephone | 215-206-9705
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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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