NPIMap

Organization Active NPI

Plastic Surgery Group, a Medical Corporation

  • Specialist
  • Corona del Mar, CA
National Provider Identifier
1689097883
Registry record updated Jan 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A30397 Issued in CA
Legal business name
PLASTIC SURGERY GROUP, A MEDICAL CORPORATION
Practice address
1101 Bayside Dr
Suite 100
Corona del Mar, CA 92625-1702
Phone
(949) 718-6900
NPI assigned
Jan 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2014

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

Authorized official

Name
Mr. Devon Niccole, MBA
Title
Ceo
Phone
(949) 718-6900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A30397 CA Primary

Addresses

Primary practice location

1101 Bayside Dr
Suite 100
Corona del Mar, CA 92625-1702

Mailing address

1101 Bayside Dr
Suite 100
Corona del Mar, CA 92625-1702
Phone (949) 718-6900

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1689097883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 BAYSIDE DR",
            "address_2": "SUITE 100",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251702",
            "telephone_number": "949-718-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 BAYSIDE DR",
            "address_2": "SUITE 100",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251702",
            "telephone_number": "949-718-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY GROUP, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "NICCOLE",
        "authorized_official_first_name": "DEVON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-718-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A30397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona del Mar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.