Provider Demographics
NPI:1376885293
Name:THOMAS, MOTTSIN LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:MOTTSIN
Middle Name:LAWRENCE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1590 ROSECRANS AVE STE D617
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3727
Mailing Address - Country:US
Mailing Address - Phone:310-360-7200
Mailing Address - Fax:424-237-3204
Practice Address - Street 1:1500 ROSECRANS AVE STE 500
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3771
Practice Address - Country:US
Practice Address - Phone:310-360-7200
Practice Address - Fax:424-237-3204
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1315082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry