Provider Demographics
NPI:1144078569
Name:PLASTIC REJUVENATION MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PLASTIC REJUVENATION MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-518-5980
Mailing Address - Street 1:25408 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6123
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:
Practice Address - Street 1:25408 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6123
Practice Address - Country:US
Practice Address - Phone:818-518-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty