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General NPI Number Information
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NPI Number | 1982774311
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Entity Type | Organization
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Legal Business Name | THEODORE R. CORWIN, M.D., P.C.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 911 HAMPSHIRE RD STE 1
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2833
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Country | US
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Telephone | 805-494-3656
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Fax | 805-778-9104
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Provider Business Mailing Address
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Address Line | 911 HAMPSHIRE RD STE 1
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2833
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Country | US
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Telephone | 805-494-3656
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Fax | 805-778-9104
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE R CORWIN
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Credential | M.D.
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Telephone | 805-494-3656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | G29196
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License Number State | CA
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