1679618177 NPI number — WOMENS WELLNESS AND COSMETIC LASER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679618177 NPI number — WOMENS WELLNESS AND COSMETIC LASER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS WELLNESS AND COSMETIC LASER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679618177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19450 DEERFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 445
Provider Business Mailing Address City Name:
LANSDOWNE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-6820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-726-9680
Provider Business Mailing Address Fax Number:
703-726-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19450 DEERFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 445
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-6820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-726-9680
Provider Business Practice Location Address Fax Number:
703-726-9780
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BESS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
703-726-9680

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  0101236781 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com