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General NPI Number Information
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NPI Number | 1407016165
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Entity Type | Organization
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Legal Business Name | LAWRENCE DINENBERG MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE SUITE 125
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City | LA JOLLA
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State | CA
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Zip | 92037-1230
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Country | US
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Telephone | 858-450-1212
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Fax | 858-453-9271
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Provider Business Mailing Address
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Address Line | 9834 GENESEE AVE SUITE 125
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City | LA JOLLA
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State | CA
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Zip | 92037-1230
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Country | US
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Telephone | 858-450-1212
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Fax | 858-453-9271
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Authorized Official
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Title or Position | OFFICER
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Name | LAWRENCE DINENBERG
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Credential | MD
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Telephone | 858-450-1212
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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 | G25011
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License Number State | CA
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