Provider Demographics
NPI:1841716008
Name:MB LASER CORP
Entity type:Organization
Organization Name:MB LASER CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-331-6913
Mailing Address - Street 1:6200 WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1400
Mailing Address - Country:US
Mailing Address - Phone:346-240-3874
Mailing Address - Fax:469-283-1758
Practice Address - Street 1:3740 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5132
Practice Address - Country:US
Practice Address - Phone:346-240-3874
Practice Address - Fax:469-283-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
TXJ3242208D00000X, 261QR0400X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty