Provider Demographics
NPI:1811503162
Name:LAFORTUNE, GEORGE THOMAS
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:LAFORTUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30310
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-0310
Mailing Address - Country:US
Mailing Address - Phone:562-682-6556
Mailing Address - Fax:
Practice Address - Street 1:7927 PAINTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2480
Practice Address - Country:US
Practice Address - Phone:562-682-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist