Organization
FOUNTAIN OF YOUTH COSMETIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANIL K GANDHI M.D. (OWNER)
(562) 653-0180
Entity
Organization
Contact information
Practice address
17100 NORWALK BLVD STE 111, CERRITOS, CA 90703-2750
(562) 653-0180
(562) 402-3029
Mailing address
17100 NORWALK BLVD STE 111, CERRITOS, CA 90703-2750
(562) 653-0180
(562) 402-3029
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A30411
CA
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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