| NPI | 1619213428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN DESCHAMPS-BRALY Owner 415-624-3922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A-121399) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A121399) |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2019-12-20 |