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General NPI Number Information
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NPI Number | 1376689638
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Entity Type | Individual
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Provider Name | MARY LAURA KESTERSON
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 531 S CENTRAL PARK AVE E
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City | ANAHEIM
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State | CA
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Zip | 92802-1471
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Country | US
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Telephone | 714-635-2011
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Fax | 714-535-7010
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Provider Business Mailing Address
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Address Line | 531 S CENTRAL PARK AVE E
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City | ANAHEIM
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State | CA
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Zip | 92802-1471
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Country | US
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Telephone | 714-635-2011
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Fax | 714-535-7010
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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 | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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