Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G058769 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | G058769 | CA |
NPI | 1043348436 |
---|---|
Provider Name | Lawrence Bruce Greenberg |
First Address | San Pedro, CA 90732 |
Second Address | San Pedro, CA 90732-3255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 13/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E52009 | (02) | CA |