Provider Demographics
NPI:1598148942
Name:WALTZMAN PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:WALTZMAN PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:WALTZMAN PLASTC & RECONSTRUCTIVE SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-448-6100
Mailing Address - Street 1:4251 LONG BEACH BLVD.
Mailing Address - Street 2:102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-448-6100
Mailing Address - Fax:562-448-6101
Practice Address - Street 1:4251 LONG BEACH BLVD.
Practice Address - Street 2:102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-448-6100
Practice Address - Fax:562-448-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128713208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty