Provider Demographics
NPI:1437468808
Name:MERTENS-ROWAN, LAURA BERNADETTE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BERNADETTE
Last Name:MERTENS-ROWAN
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 1:653 E CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2143
Mailing Address - Country:US
Mailing Address - Phone:408-370-1188
Mailing Address - Fax:408-370-1199
Practice Address - Street 1:653 E CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2143
Practice Address - Country:US
Practice Address - Phone:408-370-1188
Practice Address - Fax:408-370-1199
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist