MEDICARE: LINA'S ELECTROLYSIS CENTER LLC

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	171W00000X	Contractor
2	174400000X	Specialist

General Provider Information

NPI Number	:	1487419735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINA'S ELECTROLYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	6117 BROCKTON AVE STE 105
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2282
Country	:	US
Telephone Number	:	951-261-7956
Fax Number	:

Provider Business Practice Location Address
First Line	:	6117 BROCKTON AVE STE 105
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2282
Country	:	US
Telephone Number	:	951-261-7956
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LINA NUNEZ
Credential	:
Telephone Number	:	951-261-7956

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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