Healthcare Provider Details

I. General information

NPI: 1407063837
Provider Name (Legal Business Name): LAWRENCE CHESPAK, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5554 RESEDA BLVD SUITE 103
TARZANA CA
91356-2200
US

IV. Provider business mailing address

5554 RESEDA BLVD SUITE 103
TARZANA CA
91356-2200
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-7704
  • Fax: 818-708-7707
Mailing address:
  • Phone: 818-707-7704
  • Fax: 818-708-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG62697
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCCC9644
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE WALTER CHESPAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-707-7704