Individual
LAURA DEMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6195 LUSK BLVD STE 250, SAN DIEGO, CA 92121-3715
(858) 859-1188
Mailing address
6195 LUSK BLVD STE 250, SAN DIEGO, CA 92121-3715
(518) 421-4195
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95000375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03588341
—
NY
01
—
131003000161
FIDELIS
NY
Enumeration date
06/06/2013
Last updated
11/04/2022
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