Organization
RICHARD A. GANGNES M.D. INC.
Active
Other names
Facial Aesthetic concepts
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS GANGNES (GENERAL MANAGER)
(949) 276-4141
Entity
Organization
Contact information
Practice address
665 CAMINO DE LOS MARES STE 100, SAN CLEMENTE, CA 92673-2840
(949) 276-4141
(949) 496-2705
Mailing address
665 CAMINO DE LOS MARES STE 100, SAN CLEMENTE, CA 92673-2840
(949) 276-4141
(949) 496-2705
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
G30030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ00859Z
BLUE SHIELD
CA
Enumeration date
07/10/2006
Last updated
05/05/2010
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