Provider Demographics
NPI:1215303839
Name:RAMBIKUR, LAURA JEAN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:RAMBIKUR
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 1:1725 COMMONWEALTH AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4022
Mailing Address - Country:US
Mailing Address - Phone:928-533-7092
Mailing Address - Fax:
Practice Address - Street 1:1725 COMMONWEALTH AVE
Practice Address - Street 2:APT #3
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-4022
Practice Address - Country:US
Practice Address - Phone:928-533-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05052953390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program