Healthcare Provider Details

I. General information

NPI: 1407921471
Provider Name (Legal Business Name): LAWRENCE A SHERWIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N TUSTIN AVE SUITE G
SANTA ANA CA
92705-3605
US

IV. Provider business mailing address

800 N TUSTIN AVE SUITE G
SANTA ANA CA
92705-3605
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA23310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA23310
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA23310
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE A SHERWIN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-547-6111