Provider Demographics
NPI:1598090052
Name:LARRY S NICHTER MD & JED H HOROWITZ MD
Entity Type:Organization
Organization Name:LARRY S NICHTER MD & JED H HOROWITZ MD
Other - Org Name:PACIFIC CENTER FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-902-1100
Mailing Address - Street 1:3991 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3009
Mailing Address - Country:US
Mailing Address - Phone:949-720-3888
Mailing Address - Fax:714-902-1101
Practice Address - Street 1:3991 MACARTHUR BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3009
Practice Address - Country:US
Practice Address - Phone:949-720-3888
Practice Address - Fax:714-902-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55515208200000X
CAG39915208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92140Medicare UPIN
CAA93379Medicare UPIN