Provider Demographics
NPI:1922592989
Name:MENYUK, LAURIE B (HA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:B
Last Name:MENYUK
Suffix:
Gender:F
Credentials:HA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 MISTY CT
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2132
Mailing Address - Country:US
Mailing Address - Phone:818-355-1556
Mailing Address - Fax:
Practice Address - Street 1:5800 SANTA ROSA RD STE 123
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7060
Practice Address - Country:US
Practice Address - Phone:805-482-9821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8316237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8316OtherHEARING AID DISPENSER