Provider Demographics
NPI:1851432256
Name:AESTHETIC CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:AESTHETIC CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-967-1359
Mailing Address - Street 1:5333 HOLLISTER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2341
Mailing Address - Country:US
Mailing Address - Phone:805-967-1359
Mailing Address - Fax:805-683-3319
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:805-967-1359
Practice Address - Fax:805-683-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32832261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH401ZOtherBLUE SHIELD
CAS051340Medicare ID - Type Unspecified