Provider Demographics
NPI:1962836361
Name:LEJOLIE MEDICAL SPA
Entity Type:Organization
Organization Name:LEJOLIE MEDICAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-501-1114
Mailing Address - Street 1:13041 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2237
Mailing Address - Country:US
Mailing Address - Phone:818-501-1114
Mailing Address - Fax:818-501-1116
Practice Address - Street 1:13041 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2237
Practice Address - Country:US
Practice Address - Phone:818-501-1114
Practice Address - Fax:818-501-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52350302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization