Provider Demographics
NPI:1083060107
Name:LASER SURGERY HOLDING COMPANY, LTD
Entity Type:Organization
Organization Name:LASER SURGERY HOLDING COMPANY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-258-7003
Mailing Address - Street 1:10255 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3851
Mailing Address - Country:US
Mailing Address - Phone:602-258-7003
Mailing Address - Fax:602-682-5164
Practice Address - Street 1:2000 E SOUTHERN AVE
Practice Address - Street 2:106
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7549
Practice Address - Country:US
Practice Address - Phone:602-258-7003
Practice Address - Fax:602-682-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC7561261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical