Provider Demographics
NPI:1750413233
Name:LAWRENCE, ANTHONY XAVIER (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:XAVIER
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:102 MILE OF CARS WAY
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-474-9211
Mailing Address - Fax:619-474-2000
Practice Address - Street 1:102 MILE OF CARS WAY
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-474-9211
Practice Address - Fax:619-474-2000
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant