MEDICARE: CALIFORNIA FACE INSTITUTE APC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Y00000X	Otolaryngology Physician
2	207YS0123X	Facial Plastic Surgery Physician
3	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician

General Provider Information

NPI Number	:	1306438858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA FACE INSTITUTE APC

Provider Business Mailing Address
First Line	:	6850 BROCKTON AVE STE 108
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-313-6843
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 108
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-313-6843
Fax Number	:	951-800-1850

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMAR GUPTA
Credential	:	MD
Telephone Number	:	951-313-6843

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	08/30/2021

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