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General NPI Number Information
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NPI Number | 1396700753
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Entity Type | Organization
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Legal Business Name | HALCYON LASER & SURGERY CENTER, INC.
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 303 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 805-489-8254
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Fax | 805-474-1997
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Provider Business Mailing Address
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Address Line | 303 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 805-489-8254
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Fax | 805-474-1997
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SANJA BREWER
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Credential |
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Telephone | 805-541-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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