Provider Demographics
NPI:1518318047
Name:PADRON, LAURA G (APN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:PADRON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45210 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8860
Mailing Address - Country:US
Mailing Address - Phone:805-704-7706
Mailing Address - Fax:
Practice Address - Street 1:45210 CLUB DR
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-8860
Practice Address - Country:US
Practice Address - Phone:805-704-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041213376163W00000X
IL209-014651363LA2100X
CA95016214363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA452116OtherPTAN