Laura Ginoza, PA-C
Individual provider Active NPI Physician Assistant · Roseville, MI
NPI 1407883283 · NPPES record last updated Aug 6, 2014
Key facts
- NPI
- 1407883283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601005561 (MI)
- Practice address
- 18263 E 10 Mile Rd
Suite D
Roseville, MI 48066-5805 - Phone
- (734) 464-0887
- Fax
- (734) 402-0254
- NPI assigned
- Jun 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060810000499 | CA | Practitioner - Physician Assistant | 2365414596 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52057 | CA | MD | Physical Therapy Assistant |
| 197 | HI | MD | Audiologist |
| 5601005561 | MI | MD | Physician Assistant |
| PA 01248 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Derm Docs LLC | Past | Accepting new patients | |
| Labaza Eyecare, P.C. | Past | Accepting new patients | |
| Lake Dermatology Medical Assoc Inc | Past | Accepting new patients | |
| University Clinical Education & Research Associates | Past | Accepting new patients | |
| Alliance of Home Care Physicians, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 01248 | OR | |
| Physician Assistant | 363A00000X | 5601005561 | MI | Yes |
Addresses
Primary practice location
18263 E 10 Mile Rd
Suite D
Roseville, MI 48066-5805
Mailing address
36115 Schoolcraft Rd
Livonia, MI 48150-1216
Phone (734) 464-0887
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480F37288 | Other | MI | BLUE CROSS |
Other providers in Roseville, MI
- Marissa Nicole Gawel
- Gbogbara Inc
- John Kaoru Geddes
- Michelle M Gilliatte
- Shelby Elizabeth Gino
- Glory Counseling Services
- Glory Counseling Services
- John Theodore Golden
- Darlene Goodin
- Gerlinda Marie Gordon
All providers in Roseville, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.