Healthcare Provider Details

I. General information

NPI: 1861981557
Provider Name (Legal Business Name): LAPIDUS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 BAY LAUREL PLACE
AVILA BEACH CA
93424
US

IV. Provider business mailing address

PO BOX 490
AVILA BEACH CA
93424-0490
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-0731
  • Fax:
Mailing address:
  • Phone: 323-301-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JOHN MARTIN
Title or Position: BILLING/CREDENTIALING ADMINISTRATOR
Credential:
Phone: 833-527-4387