Healthcare Provider Details

I. General information

NPI: 1356476030
Provider Name (Legal Business Name): LAURA LEIGH MASELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA KELLY

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5210
  • Fax: 916-537-5051
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: