Basic Information
| Provider Information | |||||||||
| NPI: | 1437356714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 577 AIRPORT BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940102020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502408198 | ||||||||
| FaxNumber: | 4083285695 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S SAN MATEO DR | ||||||||
| Address2: | STE 260 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944013804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506524200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A114657 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.