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General NPI Number Information
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NPI Number | 1306982855
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Entity Type | Organization
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Legal Business Name | LA LASER CENTER, PC, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 161 AVENIDA VAQUERO
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3601
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Country | US
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Telephone | 949-652-3095
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16297
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-2297
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Country | US
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Telephone | 661-388-5240
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL TAHERI
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Credential | MD
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Telephone | 661-388-5240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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