Provider Demographics
NPI:1457691503
Name:LAWRENSON, LESLEY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:LAWRENSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E VALLEY BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3196
Mailing Address - Country:US
Mailing Address - Phone:626-956-8009
Mailing Address - Fax:626-956-8010
Practice Address - Street 1:2707 E VALLEY BLVD STE 109
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3196
Practice Address - Country:US
Practice Address - Phone:626-956-8009
Practice Address - Fax:626-956-8010
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18557207P00000X, 208D00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice