Organization
NORTHRIDGE FACIAL PLASTIC SURGERY MEDICAL GROUP A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC M KERNER MD (MEDICAL DIRECTOR)
(818) 349-0600
Entity
Organization
Contact information
Practice address
18350 ROSCOE BLVD, #318A, NORTHRIDGE, CA 91325-4109
(818) 993-9824
(818) 993-0937
Mailing address
18350 ROSCOE BLVD # 318A, NORTHRIDGE, CA 91325-4109
(818) 993-9824
(818) 993-0937
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
S051366
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SO51366
MEDICARE
CA
01
—
ZZZH1907B
BLUE SHIELD PROV IDENTICA
CA
Enumeration date
08/03/2006
Last updated
10/25/2022
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