Provider Demographics
NPI:1669584801
Name:PEMBROOK, LLORENS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:LLORENS
Middle Name:JOSEPH
Last Name:PEMBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24696 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2723
Mailing Address - Country:US
Mailing Address - Phone:310-739-1127
Mailing Address - Fax:818-436-2322
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-902-2919
Practice Address - Fax:818-902-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37585207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11694Medicare ID - Type Unspecified
CAA28413Medicare UPIN