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General NPI Number Information
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NPI Number | 1033974324
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Entity Type | Organization
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Legal Business Name | LAREDO INTERVENTIONAL CLINIC PLLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 7019 W VILLAGE BLVD STE 104
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City | LAREDO
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State | TX
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Zip | 78041-2223
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Country | US
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Telephone | 717-275-5869
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Fax |
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Provider Business Mailing Address
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Address Line | 7019 W VILLAGE BLVD STE 104
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City | LAREDO
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State | TX
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Zip | 78041-2223
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Country | US
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Telephone | 717-275-5869
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DINESH K SUNDARAKUMAR
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Credential | MD
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Telephone | 717-691-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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