Provider Demographics
NPI:1700425196
Name:CARDOSO, LAURA (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3010
Mailing Address - Country:US
Mailing Address - Phone:415-885-7779
Mailing Address - Fax:
Practice Address - Street 1:1600 DIVISADERO ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-3010
Practice Address - Country:US
Practice Address - Phone:415-885-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2024-09-13
Deactivation Date:2024-08-29
Deactivation Code:
Reactivation Date:2024-09-13
Provider Licenses
StateLicense IDTaxonomies
CAGC001785170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS