Provider Demographics
NPI:1770045569
Name:SHINGLETON, LAURA S (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:SHINGLETON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 MADRONA AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5970
Mailing Address - Country:US
Mailing Address - Phone:310-310-7924
Mailing Address - Fax:
Practice Address - Street 1:21311 MADRONA AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5970
Practice Address - Country:US
Practice Address - Phone:310-310-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIFS9985271207Q00000X
CA20A19902207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine