Provider Demographics
NPI:1356725899
Name:DOWNEY LASER INSTITUTE, INC.
Entity type:Organization
Organization Name:DOWNEY LASER INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:714-393-8809
Mailing Address - Street 1:10642 DOWNEY AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2007 WILSHIRE BLVD
Practice Address - Street 2:STE 522
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3506
Practice Address - Country:US
Practice Address - Phone:213-805-6005
Practice Address - Fax:213-805-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty