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General NPI Number Information
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NPI Number | 1871875880
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Entity Type | Organization
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Legal Business Name | NYCPLASTICSURG PLLC
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 935 PARK AVE STE 1B
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City | NEW YORK
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State | NY
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Zip | 10028-0212
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Country | US
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Telephone | 801-652-1232
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Fax | 212-628-8881
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Provider Business Mailing Address
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Address Line | 935 PARK AVE STE 1B
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City | NEW YORK
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State | NY
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Zip | 10028-0212
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Country | US
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Telephone | 801-652-1232
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Fax | 212-628-8881
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAFAEL GERARDO MAGANA
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Credential | MD
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Telephone | 801-652-1232
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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 | 239015
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License Number State | NY
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