1043649536 NPI number — MRS. LAURA E. WESTBROOK M.S.

Table of content: MRS. LAURA E. WESTBROOK M.S. (NPI 1043649536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043649536 NPI number — MRS. LAURA E. WESTBROOK M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTBROOK
Provider First Name:
LAURA
Provider Middle Name:
E.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAY
Provider Other First Name:
LAURA
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043649536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4860 Y ST
Provider Second Line Business Mailing Address:
ELLISON AMBULATORY CARE, BREAST HEALTH CTR LL SUITE 540
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-295-5841
Provider Business Mailing Address Fax Number:
916-295-5769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2279 45TH ST.
Provider Second Line Business Practice Location Address:
U.C. DAVIS CANCER CENTER
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-295-5841
Provider Business Practice Location Address Fax Number:
916-295-5769
Provider Enumeration Date:
11/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , with the licence number:  GC000243 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com