Provider Demographics
NPI:1033229323
Name:COSMETIC SURGERY CENTER OF SANTA MONICA A MEDICAL CORP
Entity Type:Organization
Organization Name:COSMETIC SURGERY CENTER OF SANTA MONICA A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-434-2495
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-434-2495
Mailing Address - Fax:310-434-2497
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-434-2495
Practice Address - Fax:310-434-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS051566261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051566Medicare ID - Type Unspecified