Healthcare Provider Details

I. General information

NPI: 1952388787
Provider Name (Legal Business Name): LORI OPENSHAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 LAGUNA CANYON ROAD SUITE 120
IRVINE CA
92618
US

IV. Provider business mailing address

1987 PORT TRINITY CIRCLE
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-5437
  • Fax: 949-951-2715
Mailing address:
  • Phone: 949-533-2210
  • Fax: 949-951-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG77940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: