Healthcare Provider Details

I. General information

NPI: 1013030360
Provider Name (Legal Business Name): RAY W. LAWRENCE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 1702
LOS ANGELES CA
90067-2020
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 1702
LOS ANGELES CA
90067-2020
US

V. Phone/Fax

Practice location:
  • Phone: 310-201-0731
  • Fax: 310-201-9665
Mailing address:
  • Phone: 310-201-0731
  • Fax: 310-201-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: