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General NPI Number Information
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NPI Number | 1073562203
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Entity Type | Individual
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Provider Name | LAWRENCE MICHAEL BRUKSCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD STE 468W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2180
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Country | US
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Telephone | 310-255-0990
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Fax | 310-255-0996
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Provider Business Mailing Address
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Address Line | 2001 SANTA MONICA BLVD. SUITE 468W
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-255-0990
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Fax | 310-255-0996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G31595
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G31595
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License Number State | CA
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