Provider Demographics
NPI:1285458414
Name:KURZRAMBO, LAURA LYNN (CAS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:KURZRAMBO
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W PALMYRA AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3701
Mailing Address - Country:US
Mailing Address - Phone:714-393-4704
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR STE K1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5975
Practice Address - Country:US
Practice Address - Phone:714-393-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC054270518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)