Provider Demographics
NPI:1265638860
Name:ALLURA SKIN & LASER CENTER, INC.
Entity Type:Organization
Organization Name:ALLURA SKIN & LASER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-344-1121
Mailing Address - Street 1:280 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3915
Mailing Address - Country:US
Mailing Address - Phone:650-344-1121
Mailing Address - Fax:
Practice Address - Street 1:280 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3915
Practice Address - Country:US
Practice Address - Phone:650-344-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty