Individual
MA TESSA LOLITA DIAZ LAYUGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 SOUTHCREST CIR, #104, SOUTHAVEN, MS 38671-6726
(662) 536-3201
(662) 536-3210
Mailing address
401 SOUTHCREST CIR, #104, SOUTHAVEN, MS 38671-6726
(662) 536-3201
(662) 536-3210
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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