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General NPI Number Information
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NPI Number | 1407883283
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Entity Type | Individual
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Provider Name | LAURA GINOZA PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 18263 E 10 MILE RD SUITE D
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City | ROSEVILLE
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State | MI
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Zip | 48066-5805
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Country | US
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Telephone | 734-464-0887
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Fax | 734-402-0254
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Provider Business Mailing Address
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Address Line | 36115 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1216
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Country | US
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Telephone | 734-464-0887
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Fax | 734-402-0254
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 01248
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601005561
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License Number State | MI
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