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General NPI Number Information
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NPI Number | 1568122505
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Entity Type | Organization
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Legal Business Name | L. PURDY MD PC
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 3415 S SEPULVEDA BLVD FL 10
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City | LOS ANGELES
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State | CA
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Zip | 90034-6060
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Country | US
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Telephone | 929-900-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 2093 PHILADELPHIA PIKE # 9395
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City | CLAYMONT
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State | DE
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Zip | 19703-2424
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Country | US
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Telephone | 929-900-5504
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA PURDY
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Credential | MD
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Telephone | 931-674-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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