Healthcare Provider Details

I. General information

NPI: 1164656229
Provider Name (Legal Business Name): VIVIAN LAQUER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MED SURG I
IRVINE CA
92697-2400
US

IV. Provider business mailing address

118 MED SURG I
IRVINE CA
92697-2400
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-4405
  • Fax: 949-824-7454
Mailing address:
  • Phone: 949-824-4405
  • Fax: 949-824-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA113693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: