Provider Demographics
NPI:1023445483
Name:CRONIN, LAURA A (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:CRONIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:EL CENTRO FAMILY HEALTH, 538 N.PASEO DE ONATE
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:773-227-3669
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST STE 114
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-704-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2014-0011363A00000X
IL085004674363A00000X
FLPA9109679363A00000X
CA58201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant