Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A26222 | CA |
Y | 111NI0900X | Internist | A26222 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A26222 | CA |
NPI | 1730114166 |
---|---|
Provider Name | Dr. John I Lauridsen |
First Address | Anaheim, CA 92807-4780 |
Second Address | Anaheim, CA 92807-4780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A83350 | (02) | CA |
AL6216584 | DEA REGISTRATION NUMBER (01) | CA |