Healthcare Provider Details

I. General information

NPI: 1720700966
Provider Name (Legal Business Name): LA LASER CENTER PC, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 G ST STE D
MERCED CA
95340-1346
US

IV. Provider business mailing address

PO BOX 16297
BEVERLY HILLS CA
90209-2297
US

V. Phone/Fax

Practice location:
  • Phone: 209-800-6000
  • Fax: 209-900-1795
Mailing address:
  • Phone: 661-388-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DANIEL TAHERI
Title or Position: OWNER
Credential: MD
Phone: 661-388-5240