Provider Demographics
NPI:1093703977
Name:LAURINO, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAURINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR STE 177
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1674
Mailing Address - Country:US
Mailing Address - Phone:480-909-3700
Mailing Address - Fax:877-839-9972
Practice Address - Street 1:595 N DOBSON RD
Practice Address - Street 2:SUITE D-71
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4226
Practice Address - Country:US
Practice Address - Phone:480-963-9000
Practice Address - Fax:480-963-0375
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0518213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ510596Medicaid
AZ2Z3286OtherHEALTHNET
AZAZ0194670OtherBLUE CROSS BLUE SHIELD
AZ4724160002Medicare NSC
AZZ74506Medicare PIN
AZZ60981Medicare PIN
AZU81411Medicare UPIN