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Organization
PLASTIC SURGERY GROUP, A MEDICAL CORPORATION
Active
Organization
PLASTIC SURGERY GROUP, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEVON NICCOLE MBA (CEO)
(949) 718-6900
Entity
Organization
Contact information
Practice address
1101 BAYSIDE DR, SUITE 100, CORONA DEL MAR, CA 92625-1702
(949) 718-6900
Mailing address
1101 BAYSIDE DR, SUITE 100, CORONA DEL MAR, CA 92625-1702
(949) 718-6900
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A30397
CA
Other
Enumeration date
01/24/2014
Last updated
01/24/2014
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