A Beau Jeu Plastic Surgery Inc.

Key facts

NPI

1316136997

Entity type

Organization (NPI type 2)

Primary specialty

Plastic and Reconstructive Surgery Physician 2086S0122X

License

G626770 (CA)

Legal business name

A BEAU JEU PLASTIC SURGERY INC.

Practice address

212 N San Mateo Dr
San Mateo, CA 94401-2609

Phone

(650) 342-1511

NPI assigned

Oct 18, 2007

Organization subpart

No

Authorized official

Name

Dr. James L Pertsch, MD

Title

President

Phone

(650) 342-1511

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 18, 2007.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1316136997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012609",
            "telephone_number": "650-342-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 N SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012609",
            "telephone_number": "650-342-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BEAU JEU PLASTIC SURGERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "PERTSCH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-342-1511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "G626770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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