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General NPI Number Information
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NPI Number | 1962475913
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Entity Type | Individual
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Provider Name | MADELYN MCCAULEY LABORIEL MD
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 2010 ZONAL AV OPD 3P-61 LAC/USC VIP-CATC
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-226-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 4765 CORBIN AVE
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City | TARZANA
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State | CA
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Zip | 91356-4916
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Country | US
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Telephone | 323-226-5086
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G33069
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License Number State | CA
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