Healthcare Provider Details

I. General information

NPI: 1285466037
Provider Name (Legal Business Name): LASER SURGERY HOLDING COMPANY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S DOBSON RD STE 2
CHANDLER AZ
85224-6290
US

IV. Provider business mailing address

2228 W NORTHERN AVE STE B210
PHOENIX AZ
85021-9336
US

V. Phone/Fax

Practice location:
  • Phone: 480-444-7491
  • Fax: 480-908-4079
Mailing address:
  • Phone: 480-444-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VELINA RUELAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-908-0956