MEDICARE: SIMI VALLEY CENTER FOR PLASTIC SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician

General Provider Information

NPI Number	:	1053428409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMI VALLEY CENTER FOR PLASTIC SURGERY

Provider Business Mailing Address
First Line	:	2435 SPRINGBROOK ST
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-1147
Country	:	US
Telephone Number	:	805-579-0821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 SYCAMORE DR STE 200
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1500
Country	:	US
Telephone Number	:	805-579-0821
Fax Number	:	805-579-0879

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL JAMES FEALY
Credential	:	M.D.
Telephone Number	:	805-579-0821

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	11/06/2012

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Directions to “SIMI VALLEY CENTER FOR PLASTIC SURGERY ” Practice Location

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