Provider Demographics
NPI:1831484526
Name:PACIFIC CENTER FOR OCULOFACIAL AND AESTHETIC PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:PACIFIC CENTER FOR OCULOFACIAL AND AESTHETIC PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SEIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-340-9763
Mailing Address - Street 1:50 S SAN MATEO DRIVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3861
Mailing Address - Country:US
Mailing Address - Phone:650-340-9763
Mailing Address - Fax:650-340-9514
Practice Address - Street 1:50 S SAN MATEO DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3861
Practice Address - Country:US
Practice Address - Phone:650-340-9763
Practice Address - Fax:650-340-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty