Illuminate Plastic Surgery, Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

A98186 Issued in CA

Legal business name

ILLUMINATE PLASTIC SURGERY, INC

Practice address

1515 El Camino Real Ste C
Palo Alto, CA 94306-1000

Phone

(650) 433-8621

Fax

(650) 322-8481

NPI assigned

Jan 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David J Boudreault, M.D.

Title

Owner

Phone

(650) 433-8621

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Molly Sherrick Boudreault, NP

  • Acute Care Nurse Practitioner
  • Carmichael, CA
  • NPI 1316276082
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1114384518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 EL CAMINO REAL STE C",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061000",
            "telephone_number": "650-433-8621",
            "fax_number": "650-322-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 EL CAMINO REAL STE C",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061000",
            "telephone_number": "650-433-8621",
            "fax_number": "650-322-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE PLASTIC SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "BOUDREAULT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-433-8621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A98186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1609057884",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beau Michael Idler, MD
• Irogue Igbinosa, MD
• Ihab Andrawess DMD
• Jennifer Maurine Ikle, MD
• Irena Ilic, MD
• Charissa Omoghena Iluore, MD
• Susan Hatsue Imae, RN
• Susan Hanae Imamura, M.D.
• Imgpa, Inc.
• Imideology Inc

• Medical Specialty Clinic/Center in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.