1992036099 NPI number — THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER

Table of content: (NPI 1992036099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992036099 NPI number — THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992036099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7425 E SHEA BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-948-3250
Provider Business Mailing Address Fax Number:
480-905-6941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7425 E SHEA BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-948-3250
Provider Business Practice Location Address Fax Number:
480-905-6941
Provider Enumeration Date:
01/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WENTZEL
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
480-948-3250

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  12814 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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