Provider Demographics
NPI:1740779677
Name:EATON, LAWRENCE C
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:C
Last Name:EATON
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 1:1380 HOWARD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2650
Mailing Address - Country:US
Mailing Address - Phone:415-255-3778
Mailing Address - Fax:415-252-3008
Practice Address - Street 1:1380 HOWARD ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2650
Practice Address - Country:US
Practice Address - Phone:415-255-3778
Practice Address - Fax:415-252-3008
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker