Healthcare Provider Details

I. General information

NPI: 1841114253
Provider Name (Legal Business Name): LAURA NAYELI DESIDERIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

IV. Provider business mailing address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9996
  • Fax: 661-272-0438
Mailing address:
  • Phone: 661-272-9996
  • Fax: 661-272-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC13655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: