ILLUMINATE PLASTIC SURGERY, INC (NPI# 1114384518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114384518 |
| Entity Type | Organization |
| Organization Name | ILLUMINATE PLASTIC SURGERY, INC |
| Practice Address |
1515 El Camino Real Ste C Palo Alto CA 94306-1000 |
| Practice Telephone | 6504338621 |
| Practice Fax Number | 6503228481 |
| Mailing Telephone | 6504338621 |
| Mailing Fax Number | 6503228481 |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |
| Authorized Official Name | DR. DAVID J BOUDREAULT (OWNER) |
| Authorized Official Telephone | 6504338621 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
A98186 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | NPI | 1609057884 | 01 |
| Street Address |
1515 EL CAMINO REAL STE C |
| City | PALO ALTO |
| State | CA |
| Zip Code | 94306-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609057884 | David Jean-guy Boudreault | Specialist | 1515 El Camino Real Ste C, Palo Alto, CA 94306-1000 | 2007-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073126538 | Vasily Salov | Massage Therapist | 2313 Park Blvd, Palo Alto, CA 94306 | 2020-08-25 |
| 1568982569 | Shian Hong | Registered Nurse | 270 Grant Avenue, Palo Alto, CA 94306 | 2017-06-21 |
| 1386092229 | Woo Jung Park | Acupuncturist | 4290 Wilkie Way #c, Palo Alto, CA 94306 | 2016-06-01 |
| 1225442205 | Keiko Gill | Chiropractor | 480 California Ave Ste 103, Palo Alto, CA 94306 | 2014-06-17 |
| 1093147092 | Thuy Nguyen | Optometrist | 109 California Ave Ste D101a, Palo Alto, CA 94306 | 2013-08-01 |
| 1750685293 | Erica Mikhli | Physician Assistant | 300 Pasteur Drive Cvrb 2nd Floor, Stanford, CA 94306 | 2010-12-24 |
| 1225262553 | Rina Biren Shah | Family Medicine | 270 Grant Ave., Mayview Community Health Center, Palo Alto, CA 94306 | 2009-05-14 |
| 1669640173 | Leah Zialcita | Physical Therapist | 2345 Yale Street, Palo Alto, CA 94306 | 2008-02-19 |
| 1578761631 | Mary June Asenathe Wagner | Dentist | 1795 El Camino Real #100, Palo Alto, CA 94306 | 2007-07-10 |
| 1972628923 | Lillian Landsman Burt | Social Worker | 2 Roosevelt Circle, Palo Alto, CA 94306 | 2007-03-20 |
| Find all providers in zip 94306 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| 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). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1154495737 | Stanford Hospital and Clinics | Clinic/Center | 900 Blake Wilbur Dr Rm W0001, Palo Alto, CA 94304-2201 | 2006-11-17 |
| 1144332859 | Stuart Martin Weisman, Md, In | Clinic/Center | 900 Welch Rd, Suite 105, Palo Alto, CA 94304-1805 | 2006-08-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.