Provider Type Icon

ILLUMINATE PLASTIC SURGERY INC NPI 1114384518


NPI Information

NPI: 1114384518
Provider Name: ILLUMINATE PLASTIC SURGERY, INC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
1515 EL CAMINO REAL STE C
PALO ALTO, CA
ZIP 94306
Phone: (650) 433-8621
Get Directions

ILLUMINATE PLASTIC SURGERY, INC is a medical specialty clinic center in Palo Alto, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). ILLUMINATE PLASTIC SURGERY, INC NPI is 1114384518. The provider is registered as an organization entity type.

The provider's business location address is:

1515 EL CAMINO REAL STE C
PALO ALTO, CA
ZIP 94306-000
Phone: (650) 433-8621
Fax: (650) 322-8481

The provider's authorized official is David J Boudreault .
The authorized official title is Owner and has the following contact phone number (650) 433-8621.

The enumeration date for this NPI number is 1/15/2016 and was last updated on 1/15/2016.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical SpecialtyA98186CALIFORNIAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11609057884OTHERCALIFORNIANPI

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.