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NPI Code Detail

MEDICARE: LAURA ELAINE RADER RBT

MEDICARE: LAURA ELAINE RADER RBT
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
1106S00000XBehavior TechnicianRBT-17-46370.CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NAOTHERCANA

General Provider Information

NPI Number : 1558868273
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ELAINE RADER RBT
Provider Business Mailing Address
First Line : 3463 FOWLER AVE
Second Line :
City : SANTA CLARA
State : CA
Zip : 95051-2715
Country : US
Telephone Number : 408-612-7481
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E HAMILTON AVE STE 105
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-0834
Country : US
Telephone Number : 408-772-3775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/09/2018

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Directions to “ LAURA ELAINE RADER RBT” Practice Location

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