Provider Demographics
NPI:1811208069
Name:LAUX, RACHAEL ANN YURIKO (RD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN YURIKO
Last Name:LAUX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 GALLATIN RD
Mailing Address - Street 2:UNIT 45
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-1693
Mailing Address - Country:US
Mailing Address - Phone:310-714-6837
Mailing Address - Fax:
Practice Address - Street 1:8939 GALLATIN RD
Practice Address - Street 2:UNIT 45
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-1693
Practice Address - Country:US
Practice Address - Phone:310-714-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA962661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered