MEDICARE: LAURIE CANO JEAN LAURIE CANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	MPSS-EUXGFN	CA

General Provider Information

NPI Number	:	1073476875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE CANO JEAN LAURIE CANO

Provider Business Mailing Address
First Line	:	205 N K ST
Second Line	:
City	:	TULARE
State	:	CA
Zip	:	93274-4005
Country	:	US
Telephone Number	:	559-687-0929
Fax Number	:	559-685-8953

Provider Business Practice Location Address
First Line	:	205 N K ST
Second Line	:
City	:	TULARE
State	:	CA
Zip	:	93274-4005
Country	:	US
Telephone Number	:	559-687-0929
Fax Number	:	559-685-8953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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