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General NPI Number Information
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NPI Number | 1336527787
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Entity Type | Organization
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Legal Business Name | HEAD TO TOE LASER CENTERS PC
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 3257 CAMINO DE LOS COCHES SUITE 203
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City | CARLSBAD
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State | CA
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Zip | 92009-8976
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Country | US
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Telephone | 760-944-9200
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Fax | 760-944-9393
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Provider Business Mailing Address
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Address Line | 3257 CAMINO DE LOS COCHES SUITE 203
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City | CARLSBAD
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State | CA
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Zip | 92009-8976
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Country | US
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Telephone | 760-944-9200
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Fax | 760-944-9393
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Authorized Official
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Title or Position | CEO
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Name | DR. PHILLIP MARK MILGRAM
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Credential | MD
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Telephone | 760-944-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A35411
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License Number State | CA
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