MEDICARE: AM COSMETIC SURGERY CLINICS 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	208200000X	Plastic Surgery Physician	A85870	CA

General Provider Information

NPI Number	:	1902088560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AM COSMETIC SURGERY CLINICS INC

Provider Business Mailing Address
First Line	:	32406 COAST HWY STE 1
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6783
Country	:	US
Telephone Number	:	949-499-4147
Fax Number	:	949-499-2585

Provider Business Practice Location Address
First Line	:	32406 COAST HWY STE 1
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6783
Country	:	US
Telephone Number	:	949-499-4147
Fax Number	:	949-499-2585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARIAN MOWLAVI
Credential	:	MD
Telephone Number	:	949-499-4147

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	02/27/2019

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