Healthcare Provider Details

I. General information

NPI: 1295728442
Provider Name (Legal Business Name): LAURIE JO PIERCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 EL CAMINO REAL STE A
CARLSBAD CA
92008-8819
US

IV. Provider business mailing address

5810 EL CAMINO REAL STE A
CARLSBAD CA
92008-8819
US

V. Phone/Fax

Practice location:
  • Phone: 760-929-8269
  • Fax: 760-929-8556
Mailing address:
  • Phone: 760-929-8269
  • Fax: 760-929-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA43009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: