Provider Demographics
NPI:1891210845
Name:ARDITO, LAURENCE JAMES (RCP)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:JAMES
Last Name:ARDITO
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-4008
Mailing Address - Country:US
Mailing Address - Phone:310-795-5915
Mailing Address - Fax:
Practice Address - Street 1:4121 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-4008
Practice Address - Country:US
Practice Address - Phone:310-795-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219602279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care