Provider Demographics
NPI:1912450065
Name:SOCAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:SOCAL PLASTIC SURGERY
Other - Org Name:SOCAL PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-435-7329
Mailing Address - Street 1:11870 SANTA MONICA BLVD STE 106-549
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2276
Mailing Address - Country:US
Mailing Address - Phone:310-435-7329
Mailing Address - Fax:310-388-1771
Practice Address - Street 1:145 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2103
Practice Address - Country:US
Practice Address - Phone:310-435-7329
Practice Address - Fax:310-388-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty