Healthcare Provider Details

I. General information

NPI: 1558521898
Provider Name (Legal Business Name): LAWRENCE GENEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 SANTA MONICA BLVD SUITE 311
WEST HOLLYWOOD CA
90046-5914
US

IV. Provider business mailing address

8235 SANTA MONICA BLVD SUITE 311
WEST HOLLYWOOD CA
90046-5914
US

V. Phone/Fax

Practice location:
  • Phone: 310-892-4284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA116320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: