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General NPI Number Information
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NPI Number | 1346007168
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Entity Type | Organization
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Legal Business Name | GLOWTOX AESTHETICS
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 910 GRAND AVE STE 203-204
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City | SAN DIEGO
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State | CA
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Zip | 92109-4046
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Country | US
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Telephone | 707-318-5424
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 REED AVE
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City | SAN DIEGO
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State | CA
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Zip | 92109-5106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | TIFFANY MARQUEZ-CARLES
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Credential | NP
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Telephone | 707-318-5424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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