Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A138160 | CA |
Y | 208600000X | Surgeon | A138160 | CA |
N | 208200000X | Surgeon | Q0560 | TX |
N | 208600000X | Surgeon | Q0560 | TX |
N | 2082S0105X | Plastic Hand Surgeon | Q0560 | TX |
N | 2086S0122X | Plastic and Reconstructive Surgery | Q0560 | TX |
NPI | 1902030075 |
---|---|
Provider Name | Dr. Mitchel Seruya |
First Address | Los Angeles, CA 90051-0717 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 08/09/2020 |