Provider Demographics
NPI:1942400882
Name:LAYUGAN, MA TESSA LOLITA DIAZ (MD)
Entity Type:Individual
Prefix:
First Name:MA TESSA
Middle Name:LOLITA DIAZ
Last Name:LAYUGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SOUTHCREST CIR
Mailing Address - Street 2:#104
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6726
Mailing Address - Country:US
Mailing Address - Phone:662-536-3201
Mailing Address - Fax:662-536-3210
Practice Address - Street 1:401 SOUTHCREST CIR
Practice Address - Street 2:#104
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6726
Practice Address - Country:US
Practice Address - Phone:662-536-3201
Practice Address - Fax:662-536-3210
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist