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NPI Code Detail

MEDICARE: LASER SURGERY HOLDING COMPANY, LTD

MEDICARE: LASER SURGERY HOLDING COMPANY, LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician
2207W00000XOphthalmology Physician
3208600000XSurgery Physician
4208C00000XColon & Rectal Surgery Physician
5208VP0014XInterventional Pain Medicine Physician
6213ES0103XFoot & Ankle Surgery Podiatrist
7207RI0011XInterventional Cardiology Physician

General Provider Information

NPI Number : 1295592731
Entity Type Code : Organization
Provider Name (Legal Business Name) : LASER SURGERY HOLDING COMPANY, LTD
Provider Business Mailing Address
First Line : 2228 W NORTHERN AVE STE B210
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-9336
Country : US
Telephone Number : 480-444-7491
Fax Number :
Provider Business Practice Location Address
First Line : 2226 W NORTHERN AVE STE C212
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-4929
Country : US
Telephone Number : 480-444-7491
Fax Number :
Authorized Official
Title or Position : ADMINSTRATOR
Name : VELINA RUELAS
Credential :
Telephone Number : 480-444-7491
Provider Enumeration Date : 03/01/2024
Last Update Date : 03/01/2024

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Directions to “LASER SURGERY HOLDING COMPANY, LTD ” Practice Location

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