Provider Demographics
NPI:1174041008
Name:LASER COSMETIC WELLNES CENTER
Entity type:Organization
Organization Name:LASER COSMETIC WELLNES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DYNA
Authorized Official - Middle Name:SWAYZER
Authorized Official - Last Name:SWAYZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-278-5741
Mailing Address - Street 1:7901 SKANSIE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7497
Mailing Address - Country:US
Mailing Address - Phone:253-858-2408
Mailing Address - Fax:253-432-4050
Practice Address - Street 1:7901 SKANSIE AVE STE 105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7497
Practice Address - Country:US
Practice Address - Phone:253-858-2408
Practice Address - Fax:253-432-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006085261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty