Provider Demographics
NPI:1861249104
Name:ELECTROLYSIS CENTER LASER HAIR REMOVAL
Entity type:Organization
Organization Name:ELECTROLYSIS CENTER LASER HAIR REMOVAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-659-2627
Mailing Address - Street 1:902 PAT BOOKER RD STE D
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4110
Mailing Address - Country:US
Mailing Address - Phone:210-659-2627
Mailing Address - Fax:
Practice Address - Street 1:902 PAT BOOKER RD STE D
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4110
Practice Address - Country:US
Practice Address - Phone:210-659-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service