Provider Demographics
NPI:1720288087
Name:DUFFY, LAURA RUTH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:RUTH
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 6TH AVE
Mailing Address - Street 2:#204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2757
Mailing Address - Country:US
Mailing Address - Phone:442-222-0298
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2757
Practice Address - Country:US
Practice Address - Phone:619-532-6950
Practice Address - Fax:619-532-5501
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA21210363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant