Healthcare Provider Details

I. General information

NPI: 1447170949
Provider Name (Legal Business Name): LAWRENCE WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 1/2 KESTER AVE
VAN NUYS CA
91405-3716
US

IV. Provider business mailing address

6817 1/2 KESTER AVE
VAN NUYS CA
91405-3716
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-6405
  • Fax:
Mailing address:
  • Phone: 818-900-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLEN LAWRENCE
Title or Position: PRESIDENT
Credential: MD
Phone: 818-900-6405