Provider Demographics
NPI:1154889061
Name:LAURETA, MARTINIANA
Entity type:Individual
Prefix:
First Name:MARTINIANA
Middle Name:
Last Name:LAURETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1929
Mailing Address - Country:US
Mailing Address - Phone:310-779-4496
Mailing Address - Fax:
Practice Address - Street 1:1032 S WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1929
Practice Address - Country:US
Practice Address - Phone:310-779-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility