Provider Demographics
NPI:1205303930
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-7491
Mailing Address - Street 1:10255 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3822
Mailing Address - Country:US
Mailing Address - Phone:480-444-7491
Mailing Address - Fax:602-682-5164
Practice Address - Street 1:1760 E FLORENCE BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4776
Practice Address - Country:US
Practice Address - Phone:480-444-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical