Provider Demographics
NPI:1720695729
Name:VILA FACIAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:VILA FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSPH
Authorized Official - Phone:415-684-8452
Mailing Address - Street 1:899 NORTHGATE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3664
Mailing Address - Country:US
Mailing Address - Phone:415-684-8452
Mailing Address - Fax:
Practice Address - Street 1:899 NORTHGATE DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3664
Practice Address - Country:US
Practice Address - Phone:415-684-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center