Provider Demographics
NPI:1013956671
Name:LAWRENCE, ALLEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18653 VENTURA BLVD # 384
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4103
Mailing Address - Country:US
Mailing Address - Phone:760-409-4267
Mailing Address - Fax:818-582-6026
Practice Address - Street 1:18653 VENTURA BLVD # 384
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4103
Practice Address - Country:US
Practice Address - Phone:760-242-8400
Practice Address - Fax:818-582-6026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-07-31
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Provider Licenses
StateLicense IDTaxonomies
CAA25501208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23104Medicare UPIN