Provider Demographics
NPI:1326185935
Name:WESTBANK PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:WESTBANK PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-349-6460
Mailing Address - Street 1:1111 MEDICAL CENTER BOULEVARD. S640
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-6460
Mailing Address - Fax:504-349-6463
Practice Address - Street 1:1111 MEDICAL CENTER BOULEVARD. S640
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6460
Practice Address - Fax:504-349-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty