Provider Demographics
NPI:1619354297
Name:LAURENCIN, LYNNEZY (MD)
Entity Type:Individual
Prefix:
First Name:LYNNEZY
Middle Name:
Last Name:LAURENCIN
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 1:360 E. 1ST STREET
Mailing Address - Street 2:# 281
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 E 1ST ST
Practice Address - Street 2:SUITE 281
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3211
Practice Address - Country:US
Practice Address - Phone:714-785-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG066042207Q00000X, 207Y00000X, 2083P0901X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine