Provider Demographics
NPI:1578763199
Name:COSMETIC SURGERY FACILITY LLC
Entity Type:Organization
Organization Name:COSMETIC SURGERY FACILITY LLC
Other - Org Name:COSMETICSURG.NET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-494-8100
Mailing Address - Street 1:1300 BELLONA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5465
Mailing Address - Country:US
Mailing Address - Phone:410-494-8100
Mailing Address - Fax:410-494-0815
Practice Address - Street 1:1300 BELLONA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5465
Practice Address - Country:US
Practice Address - Phone:410-494-8100
Practice Address - Fax:410-494-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-22
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41395208200000X
261QA1903X
MDA1462261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty