Provider Demographics
NPI:1578689592
Name:PLASTIC & RECONSTRUCTIVE SURGERY ASSOCIATES MED GRP INC
Entity Type:Organization
Organization Name:PLASTIC & RECONSTRUCTIVE SURGERY ASSOCIATES MED GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LEPORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-4241
Mailing Address - Street 1:2581 SAMARITAN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4112
Mailing Address - Country:US
Mailing Address - Phone:408-356-4241
Mailing Address - Fax:408-356-4924
Practice Address - Street 1:2581 SAMARITAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4113
Practice Address - Country:US
Practice Address - Phone:408-356-4241
Practice Address - Fax:402-356-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE274092086S0122X
CAA274092086S0122X
CA00G5918102086S0122X
CA00G4858802086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15681ZOtherBCBS
CA1356389241OtherDR LEPORE INDIVUAL NPI NUMBER
CAZZZ15681ZOtherBCBS
CA=========OtherTAX ID FOR VINCENT LEPORE
CA=========OtherTAX ID FOR VINCENT LEPORE
CA00G485880Medicare PIN
CA00G485880Medicare PIN
CAE27409Medicare UPIN
CA00G591811Medicare PIN
CA00G591811OtherBCBS
CA1356389241OtherDR LEPORE INDIVUAL NPI NUMBER