Provider Demographics
NPI:1043643315
Name:TRAUDT, LE' ZETTE J (CMP)
Entity Type:Individual
Prefix:MRS
First Name:LE' ZETTE
Middle Name:J
Last Name:TRAUDT
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 E HERNDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3381
Mailing Address - Country:US
Mailing Address - Phone:559-432-7222
Mailing Address - Fax:559-432-7541
Practice Address - Street 1:1648 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3381
Practice Address - Country:US
Practice Address - Phone:559-432-7222
Practice Address - Fax:559-432-7541
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03141979OtherUNITED HEALTHCARE