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General NPI Number Information
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NPI Number | 1922252816
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Entity Type | Organization
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Legal Business Name | LAWRENCE W. CHESPAK, M.D., A PROF CORP
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 825 N 10TH ST
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City | SANTA PAULA
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State | CA
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Zip | 93060-1309
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Country | US
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Telephone | 877-778-4151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | SIMI VALLEY
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State | CA
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Zip | 93062-0190
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Country | US
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Telephone | 877-778-4151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE W. CHESPAK
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Credential | M.D.
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Telephone | 818-400-7785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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