Provider Demographics
NPI:1215020821
Name:ORZALLI, LAWRENCE ANTHONY
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ANTHONY
Last Name:ORZALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12280 SHALE RIDGE LANE
Mailing Address - Street 2:#1
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8417
Mailing Address - Country:US
Mailing Address - Phone:530-888-9600
Mailing Address - Fax:530-888-9797
Practice Address - Street 1:12280 SHALE RIDGE LANE
Practice Address - Street 2:#1
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8417
Practice Address - Country:US
Practice Address - Phone:530-888-9600
Practice Address - Fax:530-888-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44172332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5580920001Medicare NSC