# PLASTIC AND RECONSTRUCTIVE SURGERY

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

## Provider details

- **NPI number:** 1043249972
- **Authorized official:** MRS. JUDI HICKLIN (ADMINISTRATOR)
- **Authorized official phone:** (925) 462-3700

## Contact information

- **Practice address:** 1387 SANTA RITA RD, PLEASANTON, CA 94566-5643
- **Practice address phone:** (925) 462-3700
- **Practice address fax:** (925) 462-4681
- **Mailing address:** 1387 SANTA RITA RD, PLEASANTON, CA 94566-5643
- **Mailing address phone:** (925) 462-3700
- **Mailing address fax:** (925) 462-4681

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 140000491 | CA | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 05/09/2012