Provider Demographics
NPI:1366831174
Name:PACIFIC CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:PACIFIC CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:NICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-720-3888
Mailing Address - Street 1:3991 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3009
Mailing Address - Country:US
Mailing Address - Phone:949-720-3888
Mailing Address - Fax:714-902-1101
Practice Address - Street 1:3991 MACARTHUR BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3009
Practice Address - Country:US
Practice Address - Phone:949-720-3888
Practice Address - Fax:714-902-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center