Organization
CENTRAL COAST FACIAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROMAN P BUKACHEVSKY M.D. (MEMBER-MANAGER)
(805) 434-5960
Entity
Organization
Contact information
Practice address
295 POSADA LN, SUITE B, TEMPLETON, CA 93465-4055
(805) 434-5960
(805) 434-5963
Mailing address
295 POSADA LN, SUITE B, TEMPLETON, CA 93465-4055
(805) 434-5960
(805) 434-5963
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
FNP26330
CA
Other
Enumeration date
04/28/2006
Last updated
08/21/2007
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