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General NPI Number Information
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NPI Number | 1740718345
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Entity Type | Organization
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Legal Business Name | COSMETIC LASER MEDSPA, INC.
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 1535 S LA CIENEGA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3714
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Country | US
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Telephone | 310-261-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 S LA CIENEGA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3714
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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 | MANAGER
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Name | FARSHAD SINAI
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Credential |
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Telephone | 310-261-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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