| NPI | 1700117900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY L GILLOGLY Billing Manager 949-218-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A54020) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2010-01-28 |