| Organization Name: | LA QUINTA MEDSPA, INC. |
| NPI Number: | 1053506287 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW LOREN WERNER (MEDICAL DIRECTOR) |
| Mailing Address: | 47-350 Washington Street Suite 103 La Quinta |
| State: | CA US |
| Postal Code: | 92253 |
| Phone Number: | 7603969353 |
| Fax Number: | 7605649577 |
| NPI Enumeration Date: | 09/11/2007 |
| NPI Last Update Date: | 02/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G79952 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |