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NPI Code Detail

MEDICARE: MRS. LAURA BAUTISTA ABERNATHY

MEDICARE: MRS. LAURA BAUTISTA ABERNATHY
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
1183500000XPharmacistRPH 53546CA

General Provider Information

NPI Number : 1861618902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA BAUTISTA ABERNATHY
Provider Business Mailing Address
First Line : 17615 CRABAPPLE WAY
Second Line :
City : CARSON
State : CA
Zip : 90746-7421
Country : US
Telephone Number : 310-640-2715
Fax Number : 310-640-0804
Provider Business Practice Location Address
First Line : 220 E GRAND AVE
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-3827
Country : US
Telephone Number : 310-640-2715
Fax Number : 310-640-0804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA BAUTISTA ABERNATHY ” Practice Location

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