Provider Demographics
NPI:1366676413
Name:SCHWARZ GREEN, LAURA A (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:SCHWARZ GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 N GAREY AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2774
Mailing Address - Country:US
Mailing Address - Phone:909-623-6651
Mailing Address - Fax:909-623-0455
Practice Address - Street 1:13192 HERRICK AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3931
Practice Address - Country:US
Practice Address - Phone:818-367-3235
Practice Address - Fax:818-367-7784
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABRI1243OtherLACDMH ID