Provider Demographics
NPI:1538209655
Name:RESKE, LAURA LEE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:RESKE
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 1:333 OLD MILL RD SPC 66
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-4408
Mailing Address - Country:US
Mailing Address - Phone:765-620-4935
Mailing Address - Fax:
Practice Address - Street 1:1227 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3129
Practice Address - Country:US
Practice Address - Phone:805-699-0997
Practice Address - Fax:805-292-3209
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG733902084P0800X
IN01040101A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1004217106Medicaid
IN1004217106Medicaid
IN1004217106Medicaid