Provider Demographics
NPI:1962475913
Name:LABORIEL, MADELYN MCCAULEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:MCCAULEY
Last Name:LABORIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:LABORIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4765 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4916
Mailing Address - Country:US
Mailing Address - Phone:323-226-5086
Mailing Address - Fax:
Practice Address - Street 1:2010 ZONAL AV OPD 3P-61
Practice Address - Street 2:LAC/USC VIP-CATC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics