MEDICARE: LAURA TRUEX

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	11521179	CA

General Provider Information

NPI Number	:	1902252588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA TRUEX

Provider Business Mailing Address
First Line	:	711 ORANGE GROVE AVE
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-1945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5949 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1006
Country	:	US
Telephone Number	:	323-850-7177
Fax Number	:

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

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	05/12/2016

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Directions to “ LAURA TRUEX ” Practice Location

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