Provider Demographics
NPI:1164656229
Name:LAQUER, VIVIAN (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LAQUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MED SURG I
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-2400
Mailing Address - Country:US
Mailing Address - Phone:949-824-4405
Mailing Address - Fax:949-824-7454
Practice Address - Street 1:118 MED SURG I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-2400
Practice Address - Country:US
Practice Address - Phone:949-824-4405
Practice Address - Fax:949-824-7454
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113693207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology