Provider Demographics
NPI:1740491422
Name:PV PENINSULA PLASTIC SURGERY CENTER
Entity type:Organization
Organization Name:PV PENINSULA PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DI RECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-326-3636
Mailing Address - Street 1:3400 LOMITA BLVD
Mailing Address - Street 2:SUITE #306
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4909
Mailing Address - Country:US
Mailing Address - Phone:310-326-3636
Mailing Address - Fax:310-326-6448
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:SUITE #306
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4909
Practice Address - Country:US
Practice Address - Phone:310-326-3636
Practice Address - Fax:310-326-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79401261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical