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General NPI Number Information
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NPI Number | 1740471259
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Entity Type | Organization
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Legal Business Name | GENEVIEVE A. MAC DONALD M.D. INC.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 15477 VENTURA BLVD STE 100
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3046
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Country | US
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Telephone | 818-906-2141
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Fax | 800-814-8755
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Provider Business Mailing Address
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Address Line | 15477 VENTURA BLVD STE 100
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3046
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Country | US
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Telephone | 818-906-2141
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Fax | 800-814-8755
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Authorized Official
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Title or Position | PRESIDENT
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Name | GENEVIEVE A MAC DONALD
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Credential | M.D.
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Telephone | 818-906-2141
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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 | G16852
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License Number State | CA
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