Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A25501 | CA |
NPI | 1013956671 |
---|---|
Provider Name | Dr. Allen L Lawrence |
First Address | Tarzana, CA 91356-4103 |
Second Address | Tarzana, CA 91356-4103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23104 | (02) | CA |