Healthcare Provider Details

I. General information

NPI: 1316757594
Provider Name (Legal Business Name): LAZER FOCUZ CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6259 TENOR CT
WOODBRIDGE VA
22193-6115
US

IV. Provider business mailing address

6259 TENOR CT
WOODBRIDGE VA
22193-6115
US

V. Phone/Fax

Practice location:
  • Phone: 571-343-0513
  • Fax: 571-260-5605
Mailing address:
  • Phone: 571-343-0513
  • Fax: 571-260-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE BAKER
Title or Position: NURSE
Credential: RN
Phone: 571-343-0513