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General NPI Number Information
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NPI Number | 1568072791
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Entity Type | Organization
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Legal Business Name | INFINITY AESTHETIC AND LASER CENTER LLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 204 N 12TH ST
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City | HUGO
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State | OK
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Zip | 74743-3612
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Country | US
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Telephone | 580-326-8310
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N 12TH ST
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City | HUGO
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State | OK
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Zip | 74743-3612
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Country | US
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Telephone | 580-326-8310
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | LESLIE ELAINE OATES
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Credential |
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Telephone | 580-326-8310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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