Provider Demographics
NPI: | 1649205733 |
---|---|
Name: | LIKAR, LAURA LOUISE (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | LAURA |
Middle Name: | LOUISE |
Last Name: | LIKAR |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3400 DATA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | RANCHO CORDOVA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95670-7956 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1595 SOQUEL DR STE 230 |
Practice Address - Street 2: | |
Practice Address - City: | SANTA CRUZ |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95065-1721 |
Practice Address - Country: | US |
Practice Address - Phone: | 831-226-3225 |
Practice Address - Fax: | 831-423-7579 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-11 |
Last Update Date: | 2023-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | G87140 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR0056730 | Medicaid | |
F39852 | Medicare UPIN | ||
ZZZ37105Z | Medicare ID - Type Unspecified |