MEDICARE: LA SKINCARE

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	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457020380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA SKINCARE

Provider Business Mailing Address
First Line	:	2284 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-414-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	2284 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-414-9761
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MICHELLE GRACE SANCHEZ
Credential	:	NP
Telephone Number	:	310-414-9761

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/25/2021

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Directions to “LA SKINCARE ” Practice Location

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