Healthcare Provider Details

I. General information

NPI: 1144277690
Provider Name (Legal Business Name): LAURA CECILE ACKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BURNS

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 WILSHIRE BLVD STE 114
LOS ANGELES CA
90025-5781
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-1519
  • Fax: 310-479-5673
Mailing address:
  • Phone: 763-268-4115
  • Fax: 763-268-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2170
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA4190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: