Provider Demographics
NPI:1730749748
Name:PLASTIKKIRURGI, INC.
Entity type:Organization
Organization Name:PLASTIKKIRURGI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-592-0266
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 1180W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2215
Mailing Address - Country:US
Mailing Address - Phone:310-592-0266
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 1180W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2215
Practice Address - Country:US
Practice Address - Phone:310-829-5550
Practice Address - Fax:310-829-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty