Healthcare Provider Details

I. General information

NPI: 1578690475
Provider Name (Legal Business Name): LAWRENCE WILLIAM COOKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LAWRENCE WILLIAM COOKE MD

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25255 CABOT RD STE 213
LAGUNA HILLS CA
92653-5508
US

IV. Provider business mailing address

25255 CABOT RD STE 213
LAGUNA HILLS CA
92653-5508
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-1511
  • Fax: 949-215-1512
Mailing address:
  • Phone: 949-215-1511
  • Fax: 949-215-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG71266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: