Provider Demographics
NPI:1629254230
Name:AESTHETIC PLASTIC SURGICAL INSTITUTE, A MED. CORP
Entity Type:Organization
Organization Name:AESTHETIC PLASTIC SURGICAL INSTITUTE, A MED. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-2800
Mailing Address - Street 1:31852 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:SUITE #401
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6764
Mailing Address - Country:US
Mailing Address - Phone:949-499-2800
Mailing Address - Fax:949-499-9590
Practice Address - Street 1:31852 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE #401
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-499-2800
Practice Address - Fax:949-499-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56260208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12179Medicare PIN