Provider Demographics
NPI:1013202738
Name:RUSH, LAURA A (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:RUSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:350 E DEL MAR BLVD
Mailing Address - Street 2:APT 211
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2769
Mailing Address - Country:US
Mailing Address - Phone:909-762-4570
Mailing Address - Fax:
Practice Address - Street 1:4950 W SUNSET BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5822
Practice Address - Country:US
Practice Address - Phone:800-854-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA11685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine