Healthcare Provider Details

I. General information

NPI: 1083420400
Provider Name (Legal Business Name): LAURA TAOUK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD STE 1030
LOS ANGELES CA
90025-6811
US

IV. Provider business mailing address

11645 WILSHIRE BLVD STE 1030
LOS ANGELES CA
90025-6811
US

V. Phone/Fax

Practice location:
  • Phone: 310-254-9748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-36716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: