Provider Demographics
NPI:1396383212
Name:LA JOLLA PROFESSIONAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:LA JOLLA PROFESSIONAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOLTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-457-8686
Mailing Address - Street 1:4510 EXECUTIVE DR. SUITE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-457-8686
Mailing Address - Fax:858-450-7690
Practice Address - Street 1:4510 EXECUTIVE DR. SUITE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-457-8686
Practice Address - Fax:858-450-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty