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General NPI Number Information
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NPI Number | 1659996114
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Entity Type | Organization
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Legal Business Name | LAGUNA AZUL UNLIMITED LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 6000 STAMPEDE RUN CIR APT 5312
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City | FT WORTH
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State | TX
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Zip | 76123-6123
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Country | US
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Telephone | 817-800-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 STAMPEDE RUN CIR APT 5312
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City | FORT WORTH
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State | TX
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Zip | 76123-6123
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Country | US
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Telephone | 214-227-2457
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Fax | 214-767-0880
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL D. WRIGHT
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Credential | LSA
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Telephone | 214-227-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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