Basic Information
Provider Information
NPI: 1851432256
EntityType: 2
ReplacementNPI:  
OrganizationName: AESTHETIC CENTER FOR PLASTIC SURGERY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5333 HOLLISTER AVE
Address2: SUITE 105
City: SANTA BARBARA
State: CA
PostalCode: 931112341
CountryCode: US
TelephoneNumber: 8059671359
FaxNumber: 8056833319
Practice Location
Address1: 5333 HOLLISTER AVE
Address2: SUITE 105
City: SANTA BARBARA
State: CA
PostalCode: 931112341
CountryCode: US
TelephoneNumber: 8059671359
FaxNumber: 8056833319
Other Information
ProviderEnumerationDate: 02/09/2007
LastUpdateDate: 06/16/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SOARES
AuthorizedOfficialFirstName: JULIO
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 8059671359
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903XA32832CAY Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

ID Information
IDTypeStateIssuerDescription
ZZZH401Z01CABLUE SHIELDOTHER


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