Provider Demographics
NPI:1356496012
Name:WACHSMAN, LAURA
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:WACHSMAN
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 1:1200 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-226-2170
Mailing Address - Fax:323-226-5760
Practice Address - Street 1:1240 N MISSION RD
Practice Address - Street 2:WOMEN'S AND CHILDREN'S HOSPITAL L-902
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1019
Practice Address - Country:US
Practice Address - Phone:323-226-3691
Practice Address - Fax:323-226-5692
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34368208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809BMedicare ID - Type UnspecifiedHUDSON