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NPI Code Detail

MEDICARE: LAURIE WARREN

MEDICARE: LAURIE WARREN
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
1103K00000XBehavior Analyst1-14-10444CA

General Provider Information

NPI Number : 1811388200
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE WARREN
Provider Business Mailing Address
First Line : 2911 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2715
Country : US
Telephone Number : 707-527-7032
Fax Number : 707-527-7960
Provider Business Practice Location Address
First Line : 2911 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2715
Country : US
Telephone Number : 707-527-7032
Fax Number : 707-527-7960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2015
Last Update Date : 02/06/2015

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Directions to “ LAURIE WARREN ” Practice Location

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