Aesthetic Laser & Vein Center Of The North Bay
Specialist in Santa Rosa, CA. Organization (NPI-2).
NPI number1508992199
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1508992199
- Entity type
- Organization (NPI-2)
- Legal business name
- Aesthetic Laser & Vein Center Of The North Bay
- Organization subpart
- No
- Enumeration date
- Feb 26, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 657374 | CA | Yes |
Practice location
170 Farmers Ln Ste 6bSanta Rosa, CA 95405-4768
Phone 707-542-8346
Mailing address
170 Farmers Ln Ste 6bSanta Rosa, CA 95405-4768
Authorized official
Walter W. Tom
Doctor
7075428346
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