# NORTHRIDGE FACIAL PLASTIC SURGERY MEDICAL GROUP A PROFESSIONAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003824434
- **Authorized official:** DR. MARC M KERNER MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 349-0600

## Contact information

- **Practice address:** 18350 ROSCOE BLVD, \#318A, NORTHRIDGE, CA 91325-4109
- **Practice address phone:** (818) 993-9824
- **Practice address fax:** (818) 993-0937
- **Mailing address:** 18350 ROSCOE BLVD \# 318A, NORTHRIDGE, CA 91325-4109
- **Mailing address phone:** (818) 993-9824
- **Mailing address fax:** (818) 993-0937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | S051366 | CA | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 10/25/2022