Healthcare Provider Details

I. General information

NPI: 1437585882
Provider Name (Legal Business Name): LAWRENCE GENEN MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 SANTA MONICA BLVD SUITE 300
WEST HOLLYWOOD CA
90046
US

IV. Provider business mailing address

8235 SANTA MONICA BLVD STE 302
WEST HOLLYWOOD CA
90046-5969
US

V. Phone/Fax

Practice location:
  • Phone: 310-892-4284
  • Fax:
Mailing address:
  • Phone: 888-684-2779
  • Fax: 323-366-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE GENEN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-892-4284