Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A73940 | CA |
NPI | 1023046547 |
---|---|
Provider Name | Dr. Tracy Debra Lawrence |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 10/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A739400 | (05) | CA |
00A739400 | BLUE SHIELD (01) | CA |
00A739400197 | CAL OPTIMA (01) | CA |
1356390009 | GROUP NPI (01) | CA |
AQ665Y | (02) | CA |
CE1617 | GROUP RAILROAD MEDICARE (01) | CA |
GR0016910 | GROUP MEDICAID PIN (01) | CA |
H61837 | (02) | CA |
P00407895 | RAILROAD MEDICARE (01) | CA |
W11675 | GROUP MEDICARE PIN (01) | CA |