Provider Demographics
NPI:1518651553
Name:DIMAYUGA, LAWRENCE CERENO
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CERENO
Last Name:DIMAYUGA
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 1:18 TIDEWATER CV
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1661
Mailing Address - Country:US
Mailing Address - Phone:714-519-8797
Mailing Address - Fax:
Practice Address - Street 1:18 TIDEWATER CV
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1661
Practice Address - Country:US
Practice Address - Phone:714-519-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program