Provider Demographics
NPI:1326420738
Name:HUETTNER, LAURA AINSLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:AINSLEY
Last Name:HUETTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5312
Mailing Address - Country:US
Mailing Address - Phone:323-442-5900
Mailing Address - Fax:323-442-5714
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52606OtherSTATE LICENSE