Healthcare Provider Details

I. General information

NPI: 1578625364
Provider Name (Legal Business Name): PATRICK BERWYN LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E VERNON AVE SUITE F
LOS ANGELES CA
90011-3772
US

IV. Provider business mailing address

1061 E VERNON AVE SUITE F
LOS ANGELES CA
90011-3772
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-9686
  • Fax: 323-233-0595
Mailing address:
  • Phone: 323-233-9686
  • Fax: 323-233-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA20149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA20149
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA20149
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA20149
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA20149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: