Provider Demographics
NPI:1508186883
Name:GOLD COAST ALLURE, LLC
Entity Type:Organization
Organization Name:GOLD COAST ALLURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DERMALPIGMENTOLOGIST
Authorized Official - Phone:203-918-0099
Mailing Address - Street 1:695 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1606
Mailing Address - Country:US
Mailing Address - Phone:203-918-0099
Mailing Address - Fax:
Practice Address - Street 1:695 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1606
Practice Address - Country:US
Practice Address - Phone:203-918-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty