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General NPI Number Information
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NPI Number | 1154201853
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Entity Type | Organization
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Legal Business Name | GLITT-R LLC DBA DERMALUX
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR STE 304
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4149
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Country | US
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Telephone | 760-364-0647
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Fax |
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Provider Business Mailing Address
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Address Line | 72780 COUNTRY CLUB DR STE 304
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4149
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Country | US
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Telephone | 760-364-0647
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | VERONICA RIVERA
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Credential | PMUA
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Telephone | 760-364-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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