MEDICARE: LAURA ANN WOJCICKI

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	MFT52888	CA

General Provider Information

NPI Number	:	1568795474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN WOJCICKI

Provider Business Mailing Address
First Line	:	3727 W 6TH ST STE 320
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5108
Country	:	US
Telephone Number	:	213-600-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 W 6TH ST STE 320
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5108
Country	:	US
Telephone Number	:	213-600-4272
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	03/07/2019

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Directions to “ LAURA ANN WOJCICKI ” Practice Location

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