| Organization Name: | GREEN VALLEY LASER, LLC |
| NPI Number: | 1669551271 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID S. BENJAMIN (DIRECTOR) |
| Mailing Address: | 160 Green Valley Rd Suite 201 Freedom |
| State: | CA US |
| Postal Code: | 950193160 |
| Phone Number: | 8317222445 |
| Fax Number: | 8317226032 |
| NPI Enumeration Date: | 11/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | G75256 MED DIRECTOR |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |