Provider Demographics
NPI:1700658184
Name:NATOMAS LASER & AESTHETICS
Entity Type:Organization
Organization Name:NATOMAS LASER & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:916-898-1810
Mailing Address - Street 1:4450 DUCKHORN DR STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2596
Mailing Address - Country:US
Mailing Address - Phone:916-898-1810
Mailing Address - Fax:916-333-2677
Practice Address - Street 1:4450 DUCKHORN DR STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2596
Practice Address - Country:US
Practice Address - Phone:916-898-1810
Practice Address - Fax:916-333-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center