MEDICARE: LAURA DRAPER

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	225400000X	Rehabilitation Practitioner
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	AII054770418	CA

General Provider Information

NPI Number	:	1588892772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DRAPER

Provider Business Mailing Address
First Line	:	160 N EL MOLINO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 N EL MOLINO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1805
Country	:	US
Telephone Number	:	626-792-2770
Fax Number	:

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	05/12/2021

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Practice Location Address:

160 N EL MOLINO AVE
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Practice Location Address:

160 N EL MOLINO AVE , 173 NORTH OAK KNOLL AVE
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1972945004 — JANINE MCRILEY
Practice Location Address:

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1164844205 — ELIZABETH BAO-CHAU DANG PHARM.D.
Practice Location Address:

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Directions to “ LAURA DRAPER ” Practice Location

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