Provider Demographics
NPI:1760502868
Name:HOBSON, LAURA GOATES (LAC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:GOATES
Last Name:HOBSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MYSCHKA
Other - Last Name:GOATES HOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457
Mailing Address - Country:US
Mailing Address - Phone:707-928-5834
Mailing Address - Fax:707-928-4283
Practice Address - Street 1:10685 SYCAMORE ROAD
Practice Address - Street 2:
Practice Address - City:LOCH LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95461
Practice Address - Country:US
Practice Address - Phone:707-928-5834
Practice Address - Fax:707-928-4283
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1428171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist