Provider Demographics
NPI:1700186079
Name:REAGAN PLASTIC SURGERY APC
Entity Type:Organization
Organization Name:REAGAN PLASTIC SURGERY APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-707-5090
Mailing Address - Street 1:6221 METROPOLITAN ST
Mailing Address - Street 2:#100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-3096
Mailing Address - Country:US
Mailing Address - Phone:760-707-5090
Mailing Address - Fax:760-707-5097
Practice Address - Street 1:6221 METROPOLITAN ST
Practice Address - Street 2:#100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-3096
Practice Address - Country:US
Practice Address - Phone:760-707-5090
Practice Address - Fax:760-707-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85875Medicare PIN