Provider Demographics
NPI:1336577980
Name:LA PLASTIC SURGERY, INC.
Entity Type:Organization
Organization Name:LA PLASTIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACERNA-KIMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-954-4500
Mailing Address - Street 1:1274 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5604
Mailing Address - Country:US
Mailing Address - Phone:941-954-4500
Mailing Address - Fax:941-954-4555
Practice Address - Street 1:1274 N PALM AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5604
Practice Address - Country:US
Practice Address - Phone:941-954-4500
Practice Address - Fax:941-954-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109505208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty