Plastic Surgery So Cal Medical Group, Inc.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

A78108 Issued in CA

Legal business name

PLASTIC SURGERY SO CAL MEDICAL GROUP, INC.

Practice address

250 W 1St St Ste 116
Claremont, CA 91711

Phone

(909) 624-4440

Fax

(909) 624-4448

NPI assigned

Nov 18, 2010

Organization subpart

No

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

Authorized official

Name

Devdas Wali, MDNPI 1811909732

Title

Ceo

Phone

(323) 481-8430

Specialties & licenses 1

Addresses

Other names 1

• DEVDAS WALI, MD Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Devdas Wali, M.D.

  • Plastic Surgery Physician
  • Pomona, CA
  • NPI 1811909732
  Medicare reassignment Authorized official
• Autar Kristen Wali, M.D.

  • Colon & Rectal Surgery Physician
  • Pomona, CA
  • NPI 1164601449
  NPD (past)

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542672000000",
    "number": "1609178961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 1ST ST STE 116",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114740",
            "telephone_number": "909-624-4440",
            "fax_number": "909-624-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 1ST ST STE 116",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "91711",
            "telephone_number": "909-624-4440",
            "fax_number": "909-624-4448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Vinton Ave",
            "address_2": "SUITE 102",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917673000",
            "country_code": "US",
            "telephone_number": "909-865-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PLASTIC SURGERY SO CAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2018-11-20",
        "status": "A",
        "authorized_official_last_name": "WALI",
        "authorized_official_first_name": "DEVDAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-481-8430",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A78108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEVDAS WALI, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DEVDAS WALI, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Julie Piibe, LCSW
• Pilgrim Place in Claremont (Pilgrim Place Health Services Center)
• Daniel Pinney
• Lisa Pion-Berlin, PHD
• Dragana Gajic Pitargue, LCSW
• Lucas Poirier
• Ellen Polamero, LCSW
• Alina D Ponder
• Julie Carol Porter, LCSW
• Jocelyn Suzanne Porzel, DPT

• Plastic and Reconstructive Surgery Physician in Claremont, CA
• Providers in Claremont, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.