Provider Information for 1578763199
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COSMETIC SURGERY FACILITY LLC
Other Names:Doing Business As:COSMETICSURG.NETOrganization Subpart: NO
NPI: 1578763199
Last Updated: 2014-04-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1578763199 | ||||||||||||||||
| Enumeration Date | 2007-07-22 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: Dr. RICARDO L RODRIGUEZ M.D. Title: Medical Director Phone: 4104948100 | ||||||||||||||||
| Mailing Address | 1300 BELLONA AVE SUITE C LUTHERVILLE TIMONIUM, MD 21093-5465 United States Phone: 410-494-8100 | Fax:410-494-0815 | ||||||||||||||||
| Primary Practice Address | 1300 BELLONA AVE SUITE C LUTHERVILLE TIMONIUM, MD 21093-5465 United States Phone: 410-494-8100 | Fax:410-494-0815 | ||||||||||||||||
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