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General NPI Number Information
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NPI Number | 1659093599
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Entity Type | Organization
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Legal Business Name | MENIFEE LASER CENTER, INC.
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 29798 HAUN RD. SUITE 209
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City | MENIFEE
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State | CA
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Zip | 92586
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Country | US
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Telephone | 951-672-4200
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Fax | 951-672-0835
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Provider Business Mailing Address
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Address Line | P.O. BOX 966
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City | SUNCITY
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State | CA
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Zip | 92586
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Country | US
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Telephone | 951-672-4200
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Fax | 951-672-0835
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VADIM GURVITS
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Credential | D.O.
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Telephone | 951-672-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) 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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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