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NPI Code Detail

MEDICARE: DR. LAURA MACIUIKA ED.D.

MEDICARE:  DR. LAURA  MACIUIKA  ED.D.
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
1103TC0700XClinical PsychologistPSY21143CA
2103TC0700XClinical Psychologist6640MA

General Provider Information

NPI Number : 1235276098
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA MACIUIKA ED.D.
Provider Business Mailing Address
First Line : 75 MOLOKAI CT
Second Line :
City : SAN RAMON
State : CA
Zip : 94582-1418
Country : US
Telephone Number : 925-735-1673
Fax Number :
Provider Business Practice Location Address
First Line : 3863 HOWE ST
Second Line :
City : OAKLAND
State : CA
Zip : 94611-5343
Country : US
Telephone Number : 510-910-4617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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Directions to “ DR. LAURA MACIUIKA ED.D.” Practice Location

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