Healthcare Provider Details

I. General information

NPI: 1043718570
Provider Name (Legal Business Name): LAURA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date: 02/07/2018
Reactivation Date: 02/20/2018

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042
US

IV. Provider business mailing address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3045
  • Fax:
Mailing address:
  • Phone: 323-443-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: