Organization
PACIFICA COSMETIC SURGERY CENTER, A MEDICAL CORP
Active
Parent organization
PACIFICA COSMETIC SURGERY CENTER, A MEDICAL CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PACIFICA COSMETIC SURGERY CENTER, A MEDICAL CORP
Authorized official
DR. DOUGLAS L HENDRICKS M.D. (OWNER-CEO)
(949) 640-9570
Entity
Organization
Contact information
Practice address
280 NEWPORT CENTER DR, SUITE 120, NEWPORT BEACH, CA 92660-7526
(949) 640-9570
(949) 640-9569
Mailing address
280 NEWPORT CENTER DR, SUITE 120, NEWPORT BEACH, CA 92660-7526
(949) 640-9570
(949) 640-9569
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
28839
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922165703
NPI OF PROVIDER
CA
Enumeration date
03/13/2017
Last updated
03/13/2017
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