Provider Demographics
NPI:1891707006
Name:PRESTIGE MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL MANAGEMENT
Other - Org Name:AESTHETIC PLASTIC SURGERY INSTITUTE OF SOUTHERN CALIFORNIA, MED. CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR, SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LIGORIO
Authorized Official - Middle Name:ARELLANO
Authorized Official - Last Name:CALAYCAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:909-623-1517
Mailing Address - Street 1:1980 N ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3008
Mailing Address - Country:US
Mailing Address - Phone:909-623-1517
Mailing Address - Fax:909-623-1510
Practice Address - Street 1:1980 N ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3008
Practice Address - Country:US
Practice Address - Phone:909-623-1517
Practice Address - Fax:909-623-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center