Provider Demographics
NPI:1336527787
Name:HEAD TO TOE LASER CENTERS PC
Entity Type:Organization
Organization Name:HEAD TO TOE LASER CENTERS PC
Other - Org Name:WELLNESS ETCETERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-944-9200
Mailing Address - Street 1:3257 CAMINO DE LOS COCHES
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8976
Mailing Address - Country:US
Mailing Address - Phone:760-944-9200
Mailing Address - Fax:760-944-9393
Practice Address - Street 1:3257 CAMINO DE LOS COCHES
Practice Address - Street 2:SUITE 203
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8976
Practice Address - Country:US
Practice Address - Phone:760-944-9200
Practice Address - Fax:760-944-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35411207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty