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NPI Code Detail

MEDICARE: ANTOINETTE LAURA NP

MEDICARE:   ANTOINETTE  LAURA  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner8978CA

General Provider Information

NPI Number : 1629045752
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE LAURA NP
Provider Business Mailing Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number :
Provider Business Practice Location Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 10/29/2013

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Directions to “ ANTOINETTE LAURA NP” Practice Location

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