Healthcare Provider Details

I. General information

NPI: 1659612166
Provider Name (Legal Business Name): LAURA ANN DELZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W CESAR E CHAVEZ AVE STE 201
LOS ANGELES CA
90012-2185
US

IV. Provider business mailing address

701 W CESAR E CHAVEZ AVE STE 201
LOS ANGELES CA
90012-2185
US

V. Phone/Fax

Practice location:
  • Phone: 213-217-5300
  • Fax: 213-217-5396
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: