Provider Demographics
NPI:1992084776
Name:TRILLIUM MED SPA, COSMETIC SURGERY, & LASER CENTER
Entity type:Organization
Organization Name:TRILLIUM MED SPA, COSMETIC SURGERY, & LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-597-9300
Mailing Address - Street 1:32144 AGOURA RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4031
Mailing Address - Country:US
Mailing Address - Phone:818-597-9300
Mailing Address - Fax:818-597-9328
Practice Address - Street 1:32144 AGOURA RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4031
Practice Address - Country:US
Practice Address - Phone:818-597-9300
Practice Address - Fax:818-597-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty