Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C42465 | CA |
NPI | 1063845972 |
---|---|
Provider Name | Dr. Lawrence B Sandberg |
First Address | Riverside, CA 92507-2606 |
Second Address | Riverside, CA 92507-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 14/08/2013 |