Provider Demographics
NPI:1437469848
Name:UNIVERSITY PLASTIC SURGERY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PLASTIC SURGERY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-6876
Mailing Address - Street 1:1301 20TH STREET
Mailing Address - Street 2:SUITE 470
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-829-6876
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH STREET
Practice Address - Street 2:SUITE 470
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-6876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PLASTIC SURGERY ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty