Healthcare Provider Details

I. General information

NPI: 1699331108
Provider Name (Legal Business Name): LAURI Y MAR RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURI Y WOO

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 MARENGO ST RM 2C115
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

2053 MARENGO ST RM 2C115
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6979
  • Fax:
Mailing address:
  • Phone: 323-409-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number967235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: