Provider Demographics
NPI:1336484096
Name:HIGHLY ARTISTIC SURGERY, INC
Entity Type:Organization
Organization Name:HIGHLY ARTISTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:858-487-3742
Mailing Address - Street 1:15725 POMERADO RD STE 212
Mailing Address - Street 2:HIGHLY ARTISTIC SURGERY, INC
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2060
Mailing Address - Country:US
Mailing Address - Phone:858-487-3742
Mailing Address - Fax:858-206-3742
Practice Address - Street 1:15725 POMERADO RD STE 212
Practice Address - Street 2:HIGHLY ARTISTIC SURGERY, INC
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2060
Practice Address - Country:US
Practice Address - Phone:858-487-3742
Practice Address - Fax:858-206-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105747261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083845069Medicare UPIN
CA1669663803Medicare UPIN