Provider Demographics
NPI:1639478019
Name:BUCK, LAURA C
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:BUCK
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 1:2340 VAN NESS AVE
Mailing Address - Street 2:APARTMENT #1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:650-868-1472
Mailing Address - Fax:
Practice Address - Street 1:2340 VAN NESS AVE
Practice Address - Street 2:APARTMENT #1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-1870
Practice Address - Country:US
Practice Address - Phone:650-868-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management