Provider Demographics
NPI:1578548897
Name:PALETZ, LAWRENCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:R
Last Name:PALETZ
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:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5017
Practice Address - Street 1:3801 KATELLA AVE STE 223
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6904
Practice Address - Country:US
Practice Address - Phone:562-449-4183
Practice Address - Fax:562-861-2133
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA35498HOtherINDIVIDUAL PTAN NUMBER
CAGR20092241Medicaid
CAW15909Medicare ID - Type Unspecified
CAGR20092241Medicaid