MEDICARE: ALLURE MEDICAL SPA A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1447028873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLURE MEDICAL SPA A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	135 W SHAW AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2825
Country	:	US
Telephone Number	:	559-570-2835
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 W SHAW AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2825
Country	:	US
Telephone Number	:	559-570-2835
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT TABRIZI
Credential	:	MD
Telephone Number	:	559-570-2835

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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