Healthcare Provider Details

I. General information

NPI: 1760823280
Provider Name (Legal Business Name): LAURA KURZBAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

IV. Provider business mailing address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

V. Phone/Fax

Practice location:
  • Phone: 908-583-6305
  • Fax:
Mailing address:
  • Phone: 908-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3939-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: