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General NPI Number Information
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NPI Number | 1174041008
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Entity Type | Organization
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Legal Business Name | LASER COSMETIC WELLNES CENTER
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7901 SKANSIE AVE STE 105
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City | GIG HARBOR
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State | WA
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Zip | 98335-7497
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Country | US
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Telephone | 253-858-2408
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Fax | 253-432-4050
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Provider Business Mailing Address
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Address Line | 7901 SKANSIE AVE STE 105
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City | GIG HARBOR
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State | WA
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Zip | 98335-7497
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Country | US
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Telephone | 253-858-2408
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Fax | 253-432-4050
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | DYNA SWAYZER SWAYZER
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Credential |
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Telephone | 253-278-5741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | AP30006085
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License Number State | WA
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