1619162120 NPI number — BALIKIAN FACIAL PLASTIC SURGERY, AMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619162120 NPI number — BALIKIAN FACIAL PLASTIC SURGERY, AMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALIKIAN FACIAL PLASTIC SURGERY, AMC
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:
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:
1619162120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41715 WINCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92590-4808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-719-2950
Provider Business Mailing Address Fax Number:
951-719-2951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41715 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92590-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-719-2950
Provider Business Practice Location Address Fax Number:
951-719-2951
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALIKIAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-719-2950

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A98925 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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