LA LASER CENTER, PC, A PROFESSIONAL MEDICAL CORPORATION
Complete NPI Record 1306982855
Clinic/Center - Multi-Specialty in San Clemente, CA
Active since January 30, 2007
Complete NPI Dataset
This page contains the complete raw NPPES record for La Laser Center, Pc, A Professional Medical Corporation (NPI 1306982855), a clinic/center organization in San Clemente, CA. All 43 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1306982855 Field 1/43
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/43
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/43
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: LA LASER CENTER, PC, A PROFESSIONAL MEDICAL CORPORATION Field 4/43
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: PO BOX 16297 Field 5/43
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: BEVERLY HILLS Field 6/43
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CA Field 7/43
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 902092297 Field 8/43
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/43
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6613885240 Field 10/43
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 161 AVENIDA VAQUERO Field 11/43
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SAN CLEMENTE Field 12/43
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CA Field 13/43
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 926723601 Field 14/43
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 15/43
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9496523095 Field 16/43
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: TAHERI Field 19/43
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: DANIEL Field 20/43
- The first name of the authorized official.
- Authorized Official Title or Position: OWNER Field 21/43
- The title or position of the authorized official.
- Authorized Official Telephone Number: 6613885240 Field 22/43
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207ND0101X Field 23/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 24/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207ZD0900X Field 25/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 26/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 2085R0001X Field 27/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 28/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 207N00000X Field 29/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 30/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 5: 261QM1300X Field 31/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 5: Y Field 32/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 247778 Field 33/43
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 34/43
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: AZ Field 35/43
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 36/43
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: DR. Field 37/43
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
- Authorized Official Credential Text: MD Field 38/43
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 39/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 40/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 41/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP Field 42/43
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 36
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
6145 W Chandler Blvd Ste 3
Location 1/36Chandler, AZ 85226-3425 · Phone (480) 454-8744
186 N Main St
Location 2/36Bishop, CA 93514-2737 · Phone (760) 873-8781 · Fax (760) 827-7550
2585 Miracle Mile Ste 120
Location 3/36Bullhead City, AZ 86442-7562 · Phone (928) 514-2231
125 N Church St
Location 4/36Lodi, CA 95240-2102 · Phone (209) 860-3020 · Fax (209) 860-3025
310 S Halcyon Rd Ste 106
Location 5/36Arroyo Grande, CA 93420-3863 · Phone (805) 568-7800
13613 W Camino Del Sol Ste 1
Location 6/36Sun City West, AZ 85375-4480 · Phone (480) 757-9854
22717 S Ellsworth Rd Ste B101
Location 7/36Queen Creek, AZ 85142-7572 · Phone (888) 993-3761
3008 N Dobson Rd
Location 8/36Chandler, AZ 85224-1295 · Phone (480) 535-2424 · Fax (480) 535-2420
700 N Estrella Pkwy Ste 205
Location 9/36Goodyear, AZ 85338-9330 · Phone (623) 265-6267
631 W Avenue Q Ste B
Location 10/36Palmdale, CA 93551-3892 · Phone (661) 947-9000
276 S Mill St Ste B&c
Location 11/36Tehachapi, CA 93561-1677 · Phone (661) 947-9000
3105 McHenry Ave Ste 101
Location 12/36Modesto, CA 95350-1439 · Phone (209) 575-2700
123 Margaret Ln Ste A1
Location 13/36Grass Valley, CA 95945-5268 · Phone (530) 285-1940 · Fax (530) 285-1945
300 Old River Rd Ste 120
Location 14/36Bakersfield, CA 93311-9512 · Phone (661) 322-2700
400 N Irwin St
Location 15/36Hanford, CA 93230-4426 · Phone (559) 584-2700
981 E Tuolumne Rd Ste 104
Location 16/36Turlock, CA 95382-1544 · Phone (209) 454-0494
1317 Main St Ste B
Location 17/36Delano, CA 93215-1737 · Phone (661) 430-9070
3035 S Ellsworth Rd Ste 121
Location 18/36Mesa, AZ 85212-2137 · Phone (888) 993-3761 · Fax (623) 289-3215
1200 N China Lake Blvd Ste A
Location 19/36Ridgecrest, CA 93555-2665 · Phone (760) 446-9007
3939 N Stockton Hill Rd Ste A
Location 20/36Kingman, AZ 86409-3247 · Phone (928) 662-9302
40663 Murrieta Hot Springs Rd Ste C3
Location 21/36Murrieta, CA 92562-9015 · Phone (951) 677-5341
74320 Highway 111
Location 22/36Palm Desert, CA 92260-4140 · Phone (760) 423-5610
6181 N Thesta St Ste 104
Location 23/36Fresno, CA 93710-8604 · Phone (559) 825-0300
2409 Artesia Blvd
Location 24/36Redondo Beach, CA 90278-3207 · Phone (424) 400-7722
10884 Santa Monica Blvd Fl 3
Location 25/36Los Angeles, CA 90025-7638 · Phone (310) 446-4400
1330 N Rim Dr Ste A
Location 26/36Flagstaff, AZ 86001-3138 · Phone (888) 993-3761
1842 Buenaventura Blvd
Location 27/36Redding, CA 96001-3700 · Phone (530) 986-9160 · Fax (530) 986-9165
1840 Mesquite Ave Ste G102
Location 28/36Lake Havasu City, AZ 86403-5771 · Phone (928) 719-8400 · Fax (928) 719-8402
728 Pacific Ave Ste 604
Location 29/36San Francisco, CA 94133-4449 · Phone (888) 993-3761
5600 California Ave Ste 101
Location 30/36Bakersfield, CA 93309-1614 · Phone (661) 322-2700
652 W 11th St Ste 129
Location 31/36Tracy, CA 95376-3869 · Phone (209) 575-2700
1025 N Demaree St
Location 32/36Visalia, CA 93291-4117 · Phone (559) 931-0800
4140 E Baseline Rd Ste 110
Location 33/36Mesa, AZ 85206-4413 · Phone (623) 267-5025
25802 Hemingway Ave Ste 105
Location 34/36Stevenson Ranch, CA 91381-2391 · Phone (661) 284-2600
14940 W Indian School Rd Ste 420
Location 35/36Goodyear, AZ 85395-7307 · Phone (623) 250-3090 · Fax (623) 250-3091
20414 N 27th Ave Ste 215
Location 36/36Phoenix, AZ 85027-3250 · Phone (623) 289-3210 · Fax (480) 454-8745
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
247778 Medicaid
Identifier 1/1State: AZ
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
No registry entries match your active lookup criteria.
