MEDICARE: MED SPA 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	174400000X	Specialist	A86654	CA

General Provider Information

NPI Number	:	1407931116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED SPA SURGERY INC

Provider Business Mailing Address
First Line	:	3161 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1805
Country	:	US
Telephone Number	:	323-662-0692
Fax Number	:	323-662-0368

Provider Business Practice Location Address
First Line	:	3161 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1805
Country	:	US
Telephone Number	:	323-662-0692
Fax Number	:	323-662-0368

Authorized Official
Title or Position	:	CEO
Name	:	DR. MAGDI H ELBASSIR
Credential	:	M.D
Telephone Number	:	323-662-0692

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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Directions to “MED SPA SURGERY INC ” Practice Location

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