Healthcare Provider Details

I. General information

NPI: 1992373930
Provider Name (Legal Business Name): LAURA MULLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROWLAND WAY STE 300
NOVATO CA
94945-5041
US

IV. Provider business mailing address

100 ROWLAND WAY STE 300
NOVATO CA
94945-5041
US

V. Phone/Fax

Practice location:
  • Phone: 415-878-0225
  • Fax: 415-878-0215
Mailing address:
  • Phone: 415-878-0225
  • Fax: 415-878-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA201869
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA201869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: