1578690475 NPI number — DR. LAWRENCE WILLIAM COOKE M.D.

Table of content: DR. LAWRENCE WILLIAM COOKE M.D. (NPI 1578690475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578690475 NPI number — DR. LAWRENCE WILLIAM COOKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOKE
Provider First Name:
LAWRENCE
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOKE
Provider Other First Name:
LAWRENCE
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1578690475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23521 PASEO DE VALENCIA
Provider Second Line Business Mailing Address:
SUITE B2
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-215-1511
Provider Business Mailing Address Fax Number:
949-215-1512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24331 EL TORO RD STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA WOODS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92637-2754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-215-1511
Provider Business Practice Location Address Fax Number:
949-215-1512
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  G71266 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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