Provider Demographics
NPI:1811237068
Name:SLUSSER, LAWRENCE LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LEE
Last Name:SLUSSER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43224 ORMSBY RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5117
Mailing Address - Country:US
Mailing Address - Phone:951-694-3312
Mailing Address - Fax:951-694-3420
Practice Address - Street 1:41880 KALMIA ST
Practice Address - Street 2:100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8831
Practice Address - Country:US
Practice Address - Phone:951-696-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant