Provider Demographics
NPI:1124430236
Name:GROSSMAN PLASTIC SURGERY
Entity type:Organization
Organization Name:GROSSMAN PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CNO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-981-2050
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-981-2050
Mailing Address - Fax:818-981-2382
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:STE. 200
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-981-2050
Practice Address - Fax:818-981-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66484208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty