Provider Demographics
NPI:1174679641
Name:THE SENDI COSMETIC SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:THE SENDI COSMETIC SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BUENAVENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-751-0800
Mailing Address - Street 1:5425 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3101
Mailing Address - Country:US
Mailing Address - Phone:703-751-0800
Mailing Address - Fax:703-751-4378
Practice Address - Street 1:5425 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3101
Practice Address - Country:US
Practice Address - Phone:703-751-0800
Practice Address - Fax:703-751-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA51213261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02274Medicare UPIN