Healthcare Provider Details

I. General information

NPI: 1215490685
Provider Name (Legal Business Name): LAURA MARIE RUZZANO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 1/2 FAIRBANKS PL
LOS ANGELES CA
90026-3382
US

IV. Provider business mailing address

1468 1/2 FAIRBANKS PL
LOS ANGELES CA
90026-3382
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-0812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: