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General NPI Number Information
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NPI Number | 1811185481
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Entity Type | Organization
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Legal Business Name | PREMIERE CENTER FOR COSMETIC SURGERY
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3930 PENDER DR SUITE 120
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 703-752-6608
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 W KENNEDY BLVD STE 101
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City | TAMPA
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State | FL
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Zip | 33609-3481
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Country | US
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Telephone | 813-400-1465
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Fax | 813-386-0513
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CYNTHIA TRAUTMAN
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Credential |
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Telephone | 813-305-9100
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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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