Provider Demographics
NPI:1699820878
Name:MINAGAWA, LAURETTE ELBERTA (PNP)
Entity Type:Individual
Prefix:
First Name:LAURETTE
Middle Name:ELBERTA
Last Name:MINAGAWA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:LAURETTE
Other - Middle Name:ELBERTA
Other - Last Name:MOUAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:1224 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1725
Mailing Address - Country:US
Mailing Address - Phone:619-262-9662
Mailing Address - Fax:
Practice Address - Street 1:RADY CHILDREN'S HOSPITAL AND HEALTH CENTER
Practice Address - Street 2:3020 CHILDREN'S WAY, MC 5030
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-4003
Practice Address - Fax:858-560-6798
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN494701363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics