MEDICARE: LAURIE M ENDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G61991	CA

General Provider Information

NPI Number	:	1841254190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE M ENDO MD

Provider Business Mailing Address
First Line	:	2840 LONG BEACH BLVD
Second Line	:	#230
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1531
Country	:	US
Telephone Number	:	562-595-1961
Fax Number	:	562-595-5351

Provider Business Practice Location Address
First Line	:	2840 LONG BEACH BLVD
Second Line	:	#230
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1531
Country	:	US
Telephone Number	:	562-595-1961
Fax Number	:	562-595-5351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	06/18/2010

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