Individual provider Active NPI

Deanna Lau, D.O.

  • Developmental - Behavioral Pediatrics Physician
  • Santa Rosa, CA
National Provider Identifier
1992186662
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
20A18785 Issued in CA
Practice address
121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822
Phone
(707) 303-1705
NPI assigned
Jun 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X 20A18785 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822

Mailing address

121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822
Phone (707) 303-1705

Other practice location 1

800 Washington St
Boston, MA 02111-1552
Phone (617) 636-5000

Other practice location 2

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (510) 708-6489

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dlau1767964@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210602001153 CA Practitioner - Pediatric Medicine 8628323391 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince May 24, 2021 Accepting new patients
Providence Medical Foundation CurrentSince May 24, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

1144 Sonoma Ave
Ste 113
Santa Rosa, CA 95405
Phone (707) 545-2082

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

121 Sotoyome St
Santa Rosa, CA 95405
Phone (707) 546-3141

121 Sotoyome St
Ste 203
Santa Rosa, CA 95405
Phone (707) 525-4080

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1992186662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST STE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054822",
            "telephone_number": "707-303-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST STE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054822",
            "telephone_number": "707-303-1705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Washington St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021111552",
            "country_code": "US",
            "telephone_number": "617-636-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 Ocean Pkwy",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11235",
            "country_code": "US",
            "telephone_number": "510-708-6489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAU",
        "first_name": "DEANNA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "20A18785",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dlau1767964@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1144 Sonoma Ave Ste 113",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.