Provider Demographics
NPI:1396842001
Name:GOTTLIEB, LAURA MICHELLE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CALIFORNIA STREET, SUITE 465, BOX 0844
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0844
Mailing Address - Country:US
Mailing Address - Phone:415-509-8976
Mailing Address - Fax:
Practice Address - Street 1:3333 CALIFORNIA ST
Practice Address - Street 2:SUITE 465, BOX0844
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1981
Practice Address - Country:US
Practice Address - Phone:415-509-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20060465207Q00000X
CAC54363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37737716Medicaid