MEDICARE: A BEAU JEU PLASTIC SURGERY INC.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	G626770	CA

General Provider Information

NPI Number	:	1316136997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BEAU JEU PLASTIC SURGERY INC.

Provider Business Mailing Address
First Line	:	212 N SAN MATEO DR
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-2609
Country	:	US
Telephone Number	:	650-342-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 N SAN MATEO DR
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-2609
Country	:	US
Telephone Number	:	650-342-1511
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES L PERTSCH
Credential	:	MD
Telephone Number	:	650-342-1511

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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