Provider Demographics
NPI:1073837662
Name:TIGLAO, LAWRENCE MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MATTHEW
Last Name:TIGLAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1716
Mailing Address - Country:US
Mailing Address - Phone:510-248-1000
Mailing Address - Fax:510-608-6055
Practice Address - Street 1:2000 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1716
Practice Address - Country:US
Practice Address - Phone:510-248-1000
Practice Address - Fax:510-608-6055
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118082207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology