Provider Demographics
NPI:1285023952
Name:RE-NOVA PLASTIC SURGERY ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:RE-NOVA PLASTIC SURGERY ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAVIJO-ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-657-5588
Mailing Address - Street 1:1000 STONEWOOD DR STE 320
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8386
Mailing Address - Country:US
Mailing Address - Phone:412-638-2391
Mailing Address - Fax:724-940-7728
Practice Address - Street 1:1000 STONEWOOD DR STE 320
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8386
Practice Address - Country:US
Practice Address - Phone:412-638-2391
Practice Address - Fax:724-940-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445511208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty