Organization
AESTHETIC LASER & VEIN CENTER OF THE NORTH BAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER W. TOM M.D. (DOCTOR)
(707) 542-8346
Entity
Organization
Contact information
Practice address
170 FARMERS LN STE 6B, SANTA ROSA, CA 95405-4768
(707) 542-8346
Mailing address
170 FARMERS LN STE 6B, SANTA ROSA, CA 95405-4768
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
657374
CA
Other
Enumeration date
02/26/2007
Last updated
08/22/2020
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