Provider Demographics
NPI:1437856085
Name:MANN, LAURA (MTOM, LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 LONGRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1324
Mailing Address - Country:US
Mailing Address - Phone:917-848-1343
Mailing Address - Fax:
Practice Address - Street 1:12215 VENTURA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2521
Practice Address - Country:US
Practice Address - Phone:818-254-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19681171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist