Provider Demographics
NPI:1346765542
Name:THE WENTWORTH INSTITUTE OF PLASTIC AND RECONSTRUCTIVE SURGERY, PLLC
Entity Type:Organization
Organization Name:THE WENTWORTH INSTITUTE OF PLASTIC AND RECONSTRUCTIVE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WENTWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-392-4971
Mailing Address - Street 1:801 N ED CAREY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7919
Practice Address - Country:US
Practice Address - Phone:281-300-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty