Healthcare Provider Details

I. General information

NPI: 1063477743
Provider Name (Legal Business Name): CHRISTOPHER MARK LAWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32840 PACIFIC COAST HWY E
DANA POINT CA
92629-3468
US

IV. Provider business mailing address

33422 GALLEON WAY
DANA POINT CA
92629-1610
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-2794
  • Fax: 949-305-3380
Mailing address:
  • Phone: 949-770-2794
  • Fax: 949-305-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG55969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: