Provider Demographics
NPI:1639435886
Name:MOSHARRAFA PLASTIC SURGERY PLC
Entity Type:Organization
Organization Name:MOSHARRAFA PLASTIC SURGERY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-513-8133
Mailing Address - Street 1:4611 E SHEA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:602-513-8133
Mailing Address - Fax:602-265-6286
Practice Address - Street 1:4611 E SHEA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4254
Practice Address - Country:US
Practice Address - Phone:602-513-8133
Practice Address - Fax:602-265-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty