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General NPI Number Information
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NPI Number | 1710535505
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Entity Type | Individual
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Provider Name | MRS. LUCILLE ARSUA LAWRENCE
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 3014 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94602-3212
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Country | US
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Telephone | 510-698-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 733 SKIMMER DR
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City | PATTERSON
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State | CA
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Zip | 95363-8735
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Country | US
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Telephone | 519-717-0063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | KK375277
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License Number State | CA
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