Organization
DIVINO PLASTIC SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS CHACON M.D. (PRESIDENT)
(858) 633-7546
Entity
Organization
Contact information
Practice address
180 OTAY LAKES RD, SUITE #110, BONITA, CA 91902-2443
(858) 633-7546
Mailing address
180 OTAY LAKES RD, SUITE #110, BONITA, CA 91902-2443
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A98477
CA
Other
Enumeration date
06/29/2007
Last updated
08/05/2013
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