Provider Demographics
NPI:1932823671
Name:ASESU LASER MED SPA
Entity Type:Organization
Organization Name:ASESU LASER MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA-VIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:661-495-8883
Mailing Address - Street 1:4940 VAN NUYS BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1744
Mailing Address - Country:US
Mailing Address - Phone:661-495-8883
Mailing Address - Fax:214-271-9831
Practice Address - Street 1:4940 VAN NUYS BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1744
Practice Address - Country:US
Practice Address - Phone:661-495-8883
Practice Address - Fax:214-271-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty