Organization
RYANRAE SKIN
Active
Other names
Laguna Allergy Medical Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
GILLIAN BASSIRPOUR MD (CEO, CFO)
(949) 287-4900
Entity
Organization
Contact information
Practice address
2 JOURNEY STE 201, ALISO VIEJO, CA 92656-3373
(949) 287-4900
Mailing address
2 JOURNEY STE 201, ALISO VIEJO, CA 92656-3373
(949) 287-4900
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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