Provider Demographics
NPI:1861104333
Name:LORI OPENSHAW MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LORI OPENSHAW MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:OPENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-533-2210
Mailing Address - Street 1:1401 AVOCADO AVE STE 705
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8711
Mailing Address - Country:US
Mailing Address - Phone:949-524-8890
Mailing Address - Fax:949-524-8891
Practice Address - Street 1:1401 AVOCADO AVE STE 705
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8711
Practice Address - Country:US
Practice Address - Phone:949-524-8890
Practice Address - Fax:949-524-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty