| NPI | 1003369380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN M SPIVAK Authorized Official 310-905-3331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A113632) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |