Healthcare Provider Details

I. General information

NPI: 1518828391
Provider Name (Legal Business Name): LAURA J MAYENKNECHT NRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35000 GUADALCANAL ST
SAN DIEGO CA
92140-5599
US

IV. Provider business mailing address

825 E PALOMAR ST UNIT 706
CHULA VISTA CA
91911-6982
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-0833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP48898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: