Healthcare Provider Details

I. General information

NPI: 1881632925
Provider Name (Legal Business Name): LORI R. KRIEGER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W 6TH ST SUITE 300
SAN PEDRO CA
90732-3514
US

IV. Provider business mailing address

1360 W 6TH ST SUITE 300
SAN PEDRO CA
90732-3514
US

V. Phone/Fax

Practice location:
  • Phone: 310-514-0838
  • Fax: 310-514-0425
Mailing address:
  • Phone: 310-514-0838
  • Fax: 310-514-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70792
License Number StateCA

VIII. Authorized Official

Name: LORI ROCHELLE KRIEGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-514-0838