Provider Demographics
NPI:1578004743
Name:TERRY DUBROW, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TERRY DUBROW, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-660-6030
Mailing Address - Street 1:PO BOX 940358
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0358
Mailing Address - Country:US
Mailing Address - Phone:805-581-5575
Mailing Address - Fax:310-564-0316
Practice Address - Street 1:1617 WESTCLIFF DR
Practice Address - Street 2:SUITE 207
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5524
Practice Address - Country:US
Practice Address - Phone:800-660-6030
Practice Address - Fax:310-564-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty