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General NPI Number Information
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NPI Number | 1174872998
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Entity Type | Individual
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Provider Name | LAURA E ROSE M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 555 W COMPTON BLVD SUITE 101
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City | COMPTON
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State | CA
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Zip | 90220-3085
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Country | US
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Telephone | 310-637-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 620 HAVERFORD AVE #A
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-4310
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Country | US
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Telephone | 310-922-5264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17183
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License Number State | CA
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