Healthcare Provider Details

I. General information

NPI: 1225422033
Provider Name (Legal Business Name): EDWARD P. LAURANCE, MD INC DBA WEST COAST PEDIATRIC GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W SIERRA MADRE BLVD
SIERRA MADRE CA
91024-2314
US

IV. Provider business mailing address

460 W SIERRA MADRE BLVD
SIERRA MADRE CA
91024-2314
US

V. Phone/Fax

Practice location:
  • Phone: 626-836-6900
  • Fax: 626-836-6903
Mailing address:
  • Phone: 626-836-6900
  • Fax: 626-836-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM BIBB
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-390-2911