Healthcare Provider Details

I. General information

NPI: 1922662998
Provider Name (Legal Business Name): ERICA ST LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ANAHEIM BLVD STE 250
ANAHEIM CA
92805-3872
US

IV. Provider business mailing address

100 S ANAHEIM BLVD STE 250
ANAHEIM CA
92805-3872
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6000
  • Fax: 714-527-2371
Mailing address:
  • Phone: 714-527-6000
  • Fax: 714-527-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA209750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: