Individual
MARK LAURITIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2222 N. HARBOR BLVD., FULLERTON, CA 92835
(714) 992-5701
Mailing address
11476 FOXGLOVE LN, CORONA, CA 92880-9444
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT5867
CA
Other
Enumeration date
03/18/2011
Last updated
03/18/2011
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