Provider Demographics
NPI:1710479498
Name:GROSS, LAURA ELAINE (FRAMBES)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELAINE
Last Name:GROSS
Suffix:
Gender:F
Credentials:FRAMBES
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELAINE
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:
Practice Address - Street 1:10670 WHITE ROCK RD STE 150
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6156
Practice Address - Country:US
Practice Address - Phone:916-620-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician