Provider Demographics
NPI:1952669533
Name:PREMIER PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY CENTER
Other - Org Name:TRIDENT MOUNTAIN LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-321-7100
Mailing Address - Street 1:1795 EL CAMINO REAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1164
Mailing Address - Country:US
Mailing Address - Phone:650-321-7100
Mailing Address - Fax:
Practice Address - Street 1:1795 EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1164
Practice Address - Country:US
Practice Address - Phone:650-321-7100
Practice Address - Fax:650-323-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3388OtherAAAASF