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General NPI Number Information
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NPI Number | 1487667002
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Entity Type | Organization
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Legal Business Name | CARL LAURYSSEN MD PROF CORP.
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 8201 BEVERLY BLVD STE 405
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City | LOS ANGELES
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State | CA
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Zip | 90048-4505
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Country | US
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Telephone | 323-272-4678
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 BEVERLY BLVD SUITE 405
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City | LOS ANGELES
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State | CA
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Zip | 90048-4505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARL LAURYSSEN
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Credential | M.D.
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Telephone | 310-358-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C50914
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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