Provider Demographics
NPI:1104074657
Name:CLINICA DE LAS VARICES Y LASER INC.
Entity type:Organization
Organization Name:CLINICA DE LAS VARICES Y LASER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLU
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-441-0064
Mailing Address - Street 1:613 N O CONNOR RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7529
Mailing Address - Country:US
Mailing Address - Phone:214-441-0064
Mailing Address - Fax:
Practice Address - Street 1:613 N O CONNOR RD
Practice Address - Street 2:SUITE 27
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7529
Practice Address - Country:US
Practice Address - Phone:214-441-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2992261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD75103Medicare UPIN