Healthcare Provider Details

I. General information

NPI: 1366614216
Provider Name (Legal Business Name): LAURI DAVID THRUPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DRIVE SOUTH PAVILION III
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DRIVE SOUTH BLDG 53 ROOM 220
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5477
  • Fax: 714-456-7169
Mailing address:
  • Phone: 714-456-5134
  • Fax: 714-456-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC25108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: