Provider Demographics
NPI:1699864629
Name:KLEINMAN, LAURIE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:MD
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 49130
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-9130
Mailing Address - Country:US
Mailing Address - Phone:209-829-0444
Mailing Address - Fax:208-829-0445
Practice Address - Street 1:100 WILSON RD
Practice Address - Street 2:100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7885
Practice Address - Country:US
Practice Address - Phone:831-649-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67676208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11629Medicare UPIN
CA00G676760Medicare PIN
CABV572ZMedicare PIN