Provider Demographics
NPI:1699081414
Name:BURTON, LAURA L
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:BURTON
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 1:1425 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2499
Mailing Address - Country:US
Mailing Address - Phone:310-393-1231
Mailing Address - Fax:818-360-4200
Practice Address - Street 1:1425 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2499
Practice Address - Country:US
Practice Address - Phone:310-393-1231
Practice Address - Fax:818-360-4200
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7613237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist