Provider Demographics
NPI:1659093599
Name:MENIFEE LASER CENTER, INC.
Entity Type:Organization
Organization Name:MENIFEE LASER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GURVITS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-672-4200
Mailing Address - Street 1:P.O. BOX 966
Mailing Address - Street 2:
Mailing Address - City:SUNCITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586
Mailing Address - Country:US
Mailing Address - Phone:951-672-4200
Mailing Address - Fax:951-672-0835
Practice Address - Street 1:29798 HAUN RD.
Practice Address - Street 2:SUITE 209
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-672-4200
Practice Address - Fax:951-672-0835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENIFEE LASER CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty