Provider Demographics
NPI:1235259987
Name:LUNA COSMETIC CENTER OF TOLEDO, INC.
Entity Type:Organization
Organization Name:LUNA COSMETIC CENTER OF TOLEDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PUJARI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-578-2113
Mailing Address - Street 1:11999 SAN VICENTE BLVD
Mailing Address - Street 2:STE. 440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5131
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-471-3958
Practice Address - Street 1:2821 N HOLLAND SYLVANIA RD
Practice Address - Street 2:STE. B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1851
Practice Address - Country:US
Practice Address - Phone:419-578-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty