Provider Demographics
NPI:1962727107
Name:THE CENTERFOR PLASTIC AND RECONSTRUCTIVE SURGERY OF SACRAMENTO
Entity type:Organization
Organization Name:THE CENTERFOR PLASTIC AND RECONSTRUCTIVE SURGERY OF SACRAMENTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-983-0550
Mailing Address - Street 1:2370 E BIDWELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3892
Mailing Address - Country:US
Mailing Address - Phone:916-983-0550
Mailing Address - Fax:916-983-0552
Practice Address - Street 1:2370 E BIDWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3892
Practice Address - Country:US
Practice Address - Phone:916-983-0550
Practice Address - Fax:916-983-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG054173261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE90086Medicare UPIN