Provider Demographics
NPI:1588477962
Name:MULLEN, LAURA C
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:MULLEN
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:PO BOX 3757
Mailing Address - Street 2:
Mailing Address - City:CARMEL BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:93921-3757
Mailing Address - Country:US
Mailing Address - Phone:831-277-2243
Mailing Address - Fax:
Practice Address - Street 1:3RD NE OF 8TH ON MISSION ST.
Practice Address - Street 2:
Practice Address - City:CARMEL BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:93921-9392
Practice Address - Country:US
Practice Address - Phone:831-277-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program