MEDICARE: MRS. LAUREL JANE MARION MS

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	231H00000X	Audiologist	CAAU386	CA

General Provider Information

NPI Number	:	1316152754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREL JANE MARION MS

Provider Business Mailing Address
First Line	:	5800 SANTA ROSA ROAD
Second Line	:	SANTA ROSA PLAZA #123
City	:	CAMARILLO
State	:	CA
Zip	:	93012
Country	:	US
Telephone Number	:	805-482-9821
Fax Number	:	805-388-2937

Provider Business Practice Location Address
First Line	:	5800 SANTA ROSA ROAD
Second Line	:	SANTA ROSA PLAZA #123
City	:	CAMARILLO
State	:	CA
Zip	:	93012
Country	:	US
Telephone Number	:	805-482-9821
Fax Number	:	805-388-2937

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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