Provider Demographics
NPI:1891837415
Name:PLASTIC & RECONSTRUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:PLASTIC & RECONSTRUCTIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LEPORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-4962
Mailing Address - Street 1:2581 SAMARITAN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4112
Mailing Address - Country:US
Mailing Address - Phone:408-356-4962
Mailing Address - Fax:408-356-4924
Practice Address - Street 1:2581 SAMARITAN DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4112
Practice Address - Country:US
Practice Address - Phone:408-356-4962
Practice Address - Fax:408-356-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2875261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical