Provider Demographics
NPI:1740200138
Name:DARDICK, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DARDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6029 BRISTOL PKWY
Mailing Address - Street 2:100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6643
Mailing Address - Country:US
Mailing Address - Phone:310-417-5901
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:370W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-586-9001
Practice Address - Fax:310-586-9051
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG48334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG48334BMedicare PIN