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General NPI Number Information
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NPI Number | 1164006714
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Entity Type | Organization
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Legal Business Name | LAURI I AN MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 2655 W OLYMPIC BLVD STE 207
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-388-7887
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 W OLYMPIC BLVD STE 207
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-388-7887
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MD
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Name | LAURI AN
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Credential | MD
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Telephone | 213-388-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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