Organization
LASER MEDSPA, INC.
Active
Other names
Laser Medspa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN GRAYMAN MD (PRESIDENT)
(760) 341-1300
Entity
Organization
Contact information
Practice address
73655 EL PASEO STE N, PALM DESERT, CA 92260-4304
(760) 341-1300
Mailing address
73655 EL PASEO STE N, PALM DESERT, CA 92260-4304
(760) 341-1300
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
G29724
CA
Other
Enumeration date
11/27/2017
Last updated
06/16/2018
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