Healthcare Provider Details

I. General information

NPI: 1891210845
Provider Name (Legal Business Name): LAURENCE JAMES ARDITO RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 CHARLES AVE
CULVER CITY CA
90232-4008
US

IV. Provider business mailing address

4121 CHARLES AVE
CULVER CITY CA
90232-4008
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-5915
  • Fax:
Mailing address:
  • Phone: 310-795-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number21960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: