Organization Name: | FOUR CORNERS LASER AND AESTHETICS |
NPI Number: | 1447523873 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELODY A WARREN (BILLER) |
Mailing Address: | 2901 Main Ave Ste A Durango |
State: | CO US |
Postal Code: | 813014242 |
Phone Number: | 9703851745 |
Fax Number: | |
NPI Enumeration Date: | 02/15/2012 |
NPI Last Update Date: | 02/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 33496 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
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. |