Healthcare Provider Details

I. General information

NPI: 1144385428
Provider Name (Legal Business Name): LASER & LAPAROSCOPIC INSTITUTE OF COVINA LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N SUNSET AVE #C
WEST COVINA CA
91790-2278
US

IV. Provider business mailing address

222 N SUNSET AVE #C
WEST COVINA CA
91790-2278
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-7359
  • Fax: 626-960-3932
Mailing address:
  • Phone: 626-338-7359
  • Fax: 626-960-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA L. LOERA
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-338-7359