Provider Demographics
NPI:1952637860
Name:LAWRENCE, SANDRA DAVIS
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DAVIS
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DAVIS
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAS
Mailing Address - Street 1:501 ESPLANADE
Mailing Address - Street 2:#138
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4012
Mailing Address - Country:US
Mailing Address - Phone:310-562-4379
Mailing Address - Fax:
Practice Address - Street 1:501 ESPLANADE
Practice Address - Street 2:#138
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4012
Practice Address - Country:US
Practice Address - Phone:310-562-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01099154171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator