Healthcare Provider Details

I. General information

NPI: 1497718704
Provider Name (Legal Business Name): LAWRENCE EUGENE WASPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS COURT #203
MODESTO CA
95355
US

IV. Provider business mailing address

446 SELBY LN
LIVERMORE CA
94551-6346
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-0600
  • Fax: 209-491-0116
Mailing address:
  • Phone: 209-480-3450
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG57417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: