Provider Demographics
NPI:1942621222
Name:LAWRENCE HODOR, DPM, INC
Entity Type:Organization
Organization Name:LAWRENCE HODOR, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-804-1381
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:125
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2623
Mailing Address - Country:US
Mailing Address - Phone:562-804-1381
Mailing Address - Fax:562-925-8898
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:125
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2623
Practice Address - Country:US
Practice Address - Phone:562-804-1381
Practice Address - Fax:562-925-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2949213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty