Individual
LAURELLE MARIE MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28200 BOUQUET CANYON RD STE G, SAUGUS, CA 91350-1447
(661) 312-6139
Mailing address
18513 KIMBROUGH ST, CANYON COUNTRY, CA 91351-2928
(661) 312-6139
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
SR0067900
CA
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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