Provider Demographics
NPI:1144747726
Name:GAINES, LAURA C
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2650
Mailing Address - Country:US
Mailing Address - Phone:415-255-3645
Mailing Address - Fax:415-255-3606
Practice Address - Street 1:1380 HOWARD ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2650
Practice Address - Country:US
Practice Address - Phone:415-255-3645
Practice Address - Fax:415-255-3606
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist