Healthcare Provider Details

I. General information

NPI: 1275653065
Provider Name (Legal Business Name): SUSAN E LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44758 ELM AVE
LANCASTER CA
93534-3105
US

IV. Provider business mailing address

44758 ELM AVE
LANCASTER CA
93534-3105
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-8559
  • Fax: 661-951-0369
Mailing address:
  • Phone: 661-948-8559
  • Fax: 661-951-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC41677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: