Provider Demographics
NPI:1669275665
Name:HAIRSTON, LAWRENCE KEITH JR (AE-C)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:KEITH
Last Name:HAIRSTON
Suffix:JR
Gender:M
Credentials:AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 COTTAGE WAY
Mailing Address - Street 2:SUITE G2 28906
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1474
Mailing Address - Country:US
Mailing Address - Phone:209-498-7385
Mailing Address - Fax:
Practice Address - Street 1:3400 COTTAGE WAY
Practice Address - Street 2:SUITE G2 #28906
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1474
Practice Address - Country:US
Practice Address - Phone:209-498-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426522279E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational