Provider Demographics
NPI:1982032009
Name:PACIFIC COSMETIC AND FACELIFT CENTER INC.
Entity Type:Organization
Organization Name:PACIFIC COSMETIC AND FACELIFT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VALAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-225-0101
Mailing Address - Street 1:1601 DOVE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1419
Mailing Address - Country:US
Mailing Address - Phone:949-225-0101
Mailing Address - Fax:
Practice Address - Street 1:1601 DOVE ST STE 125
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1419
Practice Address - Country:US
Practice Address - Phone:949-225-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113567208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty