Provider Demographics
NPI:1982615902
Name:COSMETIC SURGERY CLINICS
Entity Type:Organization
Organization Name:COSMETIC SURGERY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOWLAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-4147
Mailing Address - Street 1:32406 COAST HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6783
Mailing Address - Country:US
Mailing Address - Phone:949-499-4147
Mailing Address - Fax:949-499-2585
Practice Address - Street 1:32406 COAST HWY STE 1
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6783
Practice Address - Country:US
Practice Address - Phone:949-499-4147
Practice Address - Fax:949-499-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85870A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85870AMedicare ID - Type Unspecified