Healthcare Provider Details

I. General information

NPI: 1730503087
Provider Name (Legal Business Name): LUXOR MEDICAL SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 NEWMAN AVE SUITE C
HUNTINGTON BEACH CA
92647-7042
US

IV. Provider business mailing address

8101 NEWMAN AVE SUITE C
HUNTINGTON BEACH CA
92647-7042
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-1001
  • Fax:
Mailing address:
  • Phone: 714-847-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YASSER H SALEM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-847-1001