Provider Demographics
NPI:1598864845
Name:PACIFICA INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFICA INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:IMPROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-484-2855
Mailing Address - Street 1:2460 N. PONDEROSA DR #A-117
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-484-2855
Mailing Address - Fax:805-389-1245
Practice Address - Street 1:2460 N. PONDEROSA DR #A-117
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-2855
Practice Address - Fax:805-389-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty