Organization
LA JOLLA COSMETIC LASER CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULA ORTIZ (MEDICAL BILLING COORDINATOR)
(858) 454-2700
Entity
Organization
Contact information
Practice address
7720 FAY AVE, LA JOLLA, CA 92037-4309
(858) 454-2700
(858) 454-2782
Mailing address
7720 FAY AVE, LA JOLLA, CA 92037-4309
(858) 454-2700
(858) 454-2782
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588966238
—
CA
Enumeration date
12/01/2010
Last updated
06/05/2025
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