MEDICARE: MS. LAURA EILEEN LAMANTIA M.A.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1861937914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA EILEEN LAMANTIA M.A.

Provider Business Mailing Address
First Line	:	5101 SANTA MONICA BOULEVARD
Second Line	:	STE 8 PMB 1393
City	:	FRESNO
State	:	CA
Zip	:	93711
Country	:	US
Telephone Number	:	323-762-5006
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SANTA MONICA BLVD STE 8
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2480
Country	:	US
Telephone Number	:	917-539-2803
Fax Number	:

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

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	04/10/2025

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