| NPI | 1497009641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISHA FAUSTINA Manager 602-257-1498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: AZ 33016) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 33016) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |