=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396829511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE KAMINSKY DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24310 MOULTON PKWY STE A
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-855-4414
-----------------------------------------------------
Fax | 949-855-1209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24310 MOULTON PKWY STE A
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-855-4414
-----------------------------------------------------
Fax | 949-855-1209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E2543
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------