Provider Demographics
NPI:1740718345
Name:COSMETIC LASER MEDSPA, INC.
Entity type:Organization
Organization Name:COSMETIC LASER MEDSPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-261-1313
Mailing Address - Street 1:1535 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1535 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3714
Practice Address - Country:US
Practice Address - Phone:310-261-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty