Healthcare Provider Details

I. General information

NPI: 1063568814
Provider Name (Legal Business Name): LAWRENCE SPINNER M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 LYNN RD 109
THOUSAND OAKS CA
91360-1904
US

IV. Provider business mailing address

2220 LYNN RD 109
THOUSAND OAKS CA
91360-1904
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-9419
  • Fax: 805-496-2983
Mailing address:
  • Phone: 805-497-9419
  • Fax: 805-496-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG573710
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE I SPINNER
Title or Position: OWNER
Credential: M.D.
Phone: 805-497-9419