Provider Demographics
NPI:1003150434
Name:LAWRENCE, DEREK (ND)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GRAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2363
Mailing Address - Country:US
Mailing Address - Phone:760-306-4842
Mailing Address - Fax:760-306-4844
Practice Address - Street 1:620 GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2363
Practice Address - Country:US
Practice Address - Phone:760-306-4842
Practice Address - Fax:760-306-4844
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-560175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath