Provider Demographics
NPI:1356746135
Name:PLAGEMAN, LAWRENCE DREW JR (LAC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:DREW
Last Name:PLAGEMAN
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:DREW
Other - Last Name:PLAGEMAN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:200 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4668
Mailing Address - Country:US
Mailing Address - Phone:831-476-8211
Mailing Address - Fax:
Practice Address - Street 1:200 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4668
Practice Address - Country:US
Practice Address - Phone:831-476-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist