Healthcare Provider Details

I. General information

NPI: 1275677486
Provider Name (Legal Business Name): LAWRENCE DAVID PLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 SAN VICENTE BLVD
LOS ANGELES CA
90048-5426
US

IV. Provider business mailing address

1505 GLENVILLE DR
LOS ANGELES CA
90035-3107
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-1069
  • Fax:
Mailing address:
  • Phone: 310-557-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG31535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: