Provider Demographics
NPI:1144317124
Name:LAURENCE J. LASKY, MD
Entity type:Organization
Organization Name:LAURENCE J. LASKY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:JON
Authorized Official - Last Name:LASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-947-1366
Mailing Address - Street 1:131 MANHATTAN AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-5113
Mailing Address - Country:US
Mailing Address - Phone:310-947-1366
Mailing Address - Fax:
Practice Address - Street 1:3100 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5331
Practice Address - Country:US
Practice Address - Phone:714-546-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22540261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care