Healthcare Provider Details

I. General information

NPI: 1073837662
Provider Name (Legal Business Name): LAWRENCE MATTHEW TIGLAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S RIO GRANDE AVE
MONTROSE CO
81401-4847
US

IV. Provider business mailing address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-6737
  • Fax: 970-252-0112
Mailing address:
  • Phone: 510-248-1000
  • Fax: 510-608-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA118082
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0072989
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: