Healthcare Provider Details

I. General information

NPI: 1083060107
Provider Name (Legal Business Name): LASER SURGERY HOLDING COMPANY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E SOUTHERN AVE 106
TEMPE AZ
85282-7549
US

IV. Provider business mailing address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-7003
  • Fax: 602-682-5164
Mailing address:
  • Phone: 602-258-7003
  • Fax: 602-682-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC7561
License Number StateAZ

VIII. Authorized Official

Name: MRS. VELINA RUELAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-258-7003