=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639117948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE RICHARD VANMETER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 02/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 SUPERIOR AVE STE 285
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-566-8179
-----------------------------------------------------
Fax | 888-565-6545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 SUPERIOR AVE STE 285
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-566-8179
-----------------------------------------------------
Fax | 888-565-6545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------