MEDICARE: MS. LAURIE ANDERSON PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	PA13069	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548366461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE ANDERSON PAC

Provider Business Mailing Address
First Line	:	800 1/2 PROSPECT BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3206
Country	:	US
Telephone Number	:	626-441-6098
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 1/2 PROSPECT BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3206
Country	:	US
Telephone Number	:	626-441-6098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/17/2018

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