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General NPI Number Information
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NPI Number | 1821379538
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Entity Type | Organization
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Legal Business Name | THE AESTHETIC SURGERY CENTRE, PLLC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 2202 S CEDAR ST SUITE 150
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City | TACOMA
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State | WA
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Zip | 98405-2318
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Country | US
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Telephone | 253-627-2900
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Fax | 253-627-2941
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Provider Business Mailing Address
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Address Line | 2202 S CEDAR ST SUITE 100
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City | TACOMA
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State | WA
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Zip | 98405-2318
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Country | US
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Telephone | 253-838-5432
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Fax | 253-838-5433
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DAVID PRATT
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Credential | MD
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Telephone | 253-627-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 601963666
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License Number State | WA
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