| NPI | 1235663261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILLICENT OVERLEY ROVELO Owner 310-403-0562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A130080) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2018-03-17 |