Provider Demographics
NPI:1184801854
Name:PLASTIC SURGERY SPECIALISTS, INC
Entity type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-925-2880
Mailing Address - Street 1:350 BON AIR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1752
Mailing Address - Country:US
Mailing Address - Phone:415-925-2880
Mailing Address - Fax:415-925-2884
Practice Address - Street 1:350 BON AIR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1752
Practice Address - Country:US
Practice Address - Phone:415-925-2880
Practice Address - Fax:415-925-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical