Provider Demographics
NPI:1700458973
Name:THE INSTITUTE FOR ADVANCED BREAST RECONSTRUCTION INC.
Entity Type:Organization
Organization Name:THE INSTITUTE FOR ADVANCED BREAST RECONSTRUCTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DHIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-671-7956
Mailing Address - Street 1:5887 ANNIE OAKLEY RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1200
Mailing Address - Country:US
Mailing Address - Phone:818-671-7956
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DR STE 220
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1046
Practice Address - Country:US
Practice Address - Phone:818-336-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty