J S Vincent Medical Group LLC

Primary specialty

Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X

Legal business name

J S VINCENT MEDICAL GROUP LLC

Practice address

3111 Los Feliz Blvd Ste 103
Los Angeles, CA 90039-1599

Phone

(770) 895-8483

NPI assigned

Oct 17, 2020

Organization subpart

No

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

Authorized official

Name

John Butora

Title

Billing Manager

Phone

(562) 787-0225

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1602892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602979200000",
    "number": "1164021598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 LOS FELIZ BLVD STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391599",
            "telephone_number": "770-895-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 LOS FELIZ BLVD STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391599",
            "telephone_number": "770-895-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J S VINCENT MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-17",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-18",
        "status": "A",
        "authorized_official_last_name": "BUTORA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "562-787-0225"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2020; 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.