MEDICARE: LAURA RAMIREZ-RODRIGUEZ

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	106H00000X	Marriage & Family Therapist	AMFT117745	CA

General Provider Information

NPI Number	:	1356975130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA RAMIREZ-RODRIGUEZ

Provider Business Mailing Address
First Line	:	12014 BURTON ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1518
Country	:	US
Telephone Number	:	818-632-4039
Fax Number	:

Provider Business Practice Location Address
First Line	:	12014 BURTON ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1518
Country	:	US
Telephone Number	:	818-632-4039
Fax Number	:

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

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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