Divino Plastic Surgery, Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A98477 Issued in CA

Legal business name

DIVINO PLASTIC SURGERY, INC.

Practice address

180 Otay Lakes Rd
Suite #110
Bonita, CA 91902-2443

Phone

(858) 633-7546

NPI assigned

Jun 29, 2007

Organization subpart

No

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

Authorized official

Name

Carlos Chacon, M.D.

Title

President

Phone

(858) 633-7546

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375660800000",
    "number": "1629275946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 OTAY LAKES RD",
            "address_2": "SUITE #110",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919022443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 OTAY LAKES RD",
            "address_2": "SUITE #110",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919022443",
            "telephone_number": "858-633-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINO PLASTIC SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2013-08-05",
        "status": "A",
        "authorized_official_last_name": "CHACON",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-633-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A98477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alma Maria Cortez
• Pamela Sue Davidson, CNS
• Isaac Jordan Davis, DO
• Steven Gorgas Detsch, D.D.S.
• Thuy-Tien Diep
• Laura Nicole Dolland
• Monica Dolland, DC
• Michele Alaine Dumstorff, PHARM. D.
• Lilinda Cruz Enano, DMD
• Carlos Manuel Espana, DDS

• Surgery Physician in Bonita, CA
• Providers in Bonita, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.