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General NPI Number Information
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NPI Number | 1720231509
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Entity Type | Organization
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Legal Business Name | CORINTH LASER CENTER INC
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 615 N CASS ST
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City | CORINTH
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State | MS
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Zip | 38834-4928
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Country | US
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Telephone | 662-287-1516
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Fax | 662-287-1517
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Provider Business Mailing Address
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Address Line | PO BOX 2485
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City | CORINTH
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State | MS
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Zip | 38835-2485
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Country | US
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Telephone | 662-287-1516
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Fax | 662-287-1517
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Authorized Official
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Title or Position | OWNER/MD
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Name | ANGEL A RODRIGUEZ
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Credential |
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Telephone | 662-287-1516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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