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General NPI Number Information
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NPI Number | 1144385428
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Entity Type | Organization
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Legal Business Name | LASER & LAPAROSCOPIC INSTITUTE OF COVINA LTD.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 222 N SUNSET AVE #C
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City | WEST COVINA
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State | CA
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Zip | 91790-2278
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Country | US
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Telephone | 626-338-7359
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Fax | 626-960-3932
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Provider Business Mailing Address
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Address Line | 222 N SUNSET AVE #C
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City | WEST COVINA
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State | CA
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Zip | 91790-2278
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Country | US
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Telephone | 626-338-7359
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Fax | 626-960-3932
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AMANDA L. LOERA
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Credential |
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Telephone | 626-338-7359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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