Organization
LA QUINTA MEDSPA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LOREN WERNER M.D. (MEDICAL DIRECTOR)
(760) 396-9353
Entity
Organization
Contact information
Practice address
47-350 WASHINGTON STREET, SUITE 103, LA QUINTA, CA 92253
(760) 396-9353
(760) 564-9577
Mailing address
47350 WASHINGTON ST, SUITE 103, LA QUINTA, CA 92253-8847
(760) 396-9353
(760) 564-9577
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G79952
CA
Other
Enumeration date
09/11/2007
Last updated
02/22/2010
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