Healthcare Provider Details

I. General information

NPI: 1437255981
Provider Name (Legal Business Name): ALICE JANE LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CRESTVIEW DR
WATSONVILLE CA
95076
US

IV. Provider business mailing address

1080 EMELINE AVE
SANTA CRUZ CA
95060
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8400
  • Fax: 831-763-8237
Mailing address:
  • Phone: 831-763-8400
  • Fax: 831-763-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG70667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: