Healthcare Provider Details

I. General information

NPI: 1760502868
Provider Name (Legal Business Name): LAURA GOATES HOBSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MYSCHKA GOATES HOBSON LAC

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10685 SYCAMORE ROAD
LOCH LOMOND CA
95461
US

IV. Provider business mailing address

PO BOX 758
LOWER LAKE CA
95457
US

V. Phone/Fax

Practice location:
  • Phone: 707-928-5834
  • Fax: 707-928-4283
Mailing address:
  • Phone: 707-928-5834
  • Fax: 707-928-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: