Healthcare Provider Details

I. General information

NPI: 1609127133
Provider Name (Legal Business Name): MARY ANN JANICE LAUDICO VO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANN JANICE MALLORCA LAUDICO R.N.

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST FL 4
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7400
  • Fax:
Mailing address:
  • Phone: 323-442-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22374
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002265
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1070399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: