Provider Demographics
NPI:1881060135
Name:LAGUNA AESTHETICS & FAMILY WELLNESS CENTER, INC
Entity type:Organization
Organization Name:LAGUNA AESTHETICS & FAMILY WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYAWAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-632-8087
Mailing Address - Street 1:1100 S COAST HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2968
Mailing Address - Country:US
Mailing Address - Phone:949-632-8087
Mailing Address - Fax:949-715-5889
Practice Address - Street 1:1100 S COAST HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2968
Practice Address - Country:US
Practice Address - Phone:949-632-8087
Practice Address - Fax:949-715-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty