Provider Demographics
NPI:1295708816
Name:MABIE, LAURA E (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:MABIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 VISTA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3607
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-5583
Practice Address - Fax:818-790-9517
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF79441Medicare UPIN