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Provider Information for 1578763199

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COSMETIC SURGERY FACILITY LLC

Other Name:   Doing Business As: COSMETICSURG.NET
Organization Subpart: NO

Organization NPI: 1578763199

Calendar Last Updated: 2014-04-15

Details

Name Value
NPI 1578763199
Enumeration Date 2007-07-22
NPI Type 2- Organization
Status Active
Mailing Address 1300 BELLONA AVE SUITE C
LUTHERVILLE TIMONIUM, MD 21093-5465
United States

Phone: 410-494-8100 | Fax: 410-494-0815
View Map External Link
Primary Practice Address 1300 BELLONA AVE SUITE C
LUTHERVILLE TIMONIUM, MD 21093-5465
United States

Phone: 410-494-8100 | Fax: 410-494-0815
View Map External Link
Authorized Official Information Name: DR. RICARDO L RODRIGUEZ M.D.
Title: MEDICAL DIRECTOR
Phone: 410-494-8100
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 261QA1903X - Clinic/Center Ambulatory Surgical MD A1462
No 261QA1903X - Clinic/Center Ambulatory Surgical
No 193400000X SINGLE SPECIALTY GROUP
208200000X - Plastic Surgery		 MD D41395
Other Identifiers
Issuer State Number