PLASTIC AND RECONSTRUCTIVE SURGERY NPI 1043249972

NPI Information

  • NPI: 1043249972
  • Provider Name: PLASTIC AND RECONSTRUCTIVE SURGERY
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 05D2035289
  • Address: 1387 SANTA RITA RD
    PLEASANTON, CA
    ZIP 94566
  • Phone: (925) 462-3700

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NPI Details

PLASTIC AND RECONSTRUCTIVE SURGERY is an ambulatory surgical clinic center in Pleasanton, CA. PLASTIC AND RECONSTRUCTIVE SURGERY NPI is 1043249972. The provider is registered as an organization entity type.

The provider's business location address is:

1387 SANTA RITA RD
PLEASANTON, CA
ZIP 94566-643
Phone: (925) 462-3700
Fax: (925) 462-4681

The provider's authorized official is Judi Hicklin .
The authorized official title is Administrator and has the following contact phone number (925) 462-3700.

The CLIA number assigned to this NPI record is 05D2035289 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2006 and was last updated on 5/9/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory Surgical140000491CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1051102OTHERCALIFORNIABLUE CROSS
2ZZZ98772ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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