Provider Demographics
NPI:1154201853
Name:GLITT-R LLC DBA DERMALUX
Entity type:Organization
Organization Name:GLITT-R LLC DBA DERMALUX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PMUA
Authorized Official - Phone:760-364-0647
Mailing Address - Street 1:72780 COUNTRY CLUB DR STE 304
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4149
Mailing Address - Country:US
Mailing Address - Phone:760-364-0647
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 304
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4149
Practice Address - Country:US
Practice Address - Phone:760-364-0647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty