Provider Demographics
NPI:1568760080
Name:RESTORATION CENTER FOR PLASTIC SUGERY, LLC.
Entity Type:Organization
Organization Name:RESTORATION CENTER FOR PLASTIC SUGERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-776-9555
Mailing Address - Street 1:2865 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2910
Mailing Address - Country:US
Mailing Address - Phone:561-776-9555
Mailing Address - Fax:561-776-8495
Practice Address - Street 1:2865 PGA BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2910
Practice Address - Country:US
Practice Address - Phone:561-776-9555
Practice Address - Fax:561-776-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 72823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty