Provider Demographics
NPI:1508133422
Name:STRAUSS, LAURA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 CALMAR VISTA RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-2303
Mailing Address - Country:US
Mailing Address - Phone:415-717-3805
Mailing Address - Fax:
Practice Address - Street 1:5401 NORRIS CANYON RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5406
Practice Address - Country:US
Practice Address - Phone:925-277-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50951OtherPHYSICIAN ASSISTANT