Provider Demographics
NPI:1912291394
Name:COSMETIC & RECONSTRUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:COSMETIC & RECONSTRUCTIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-283-8811
Mailing Address - Street 1:911 MORAGA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4579
Mailing Address - Country:US
Mailing Address - Phone:925-283-8811
Mailing Address - Fax:925-283-8812
Practice Address - Street 1:911 MORAGA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4579
Practice Address - Country:US
Practice Address - Phone:925-283-8811
Practice Address - Fax:925-283-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical