Provider Demographics
NPI:1720185614
Name:OWUSU, LAWRENCE JAMES YAW (PAC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JAMES YAW
Last Name:OWUSU
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE B301
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-753-1104
Mailing Address - Fax:760-436-2075
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-941-7336
Practice Address - Fax:760-943-6494
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004790363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCJXJMedicare PIN