Basic Information
Provider Information | |||||||||
NPI: | 1124131446 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PIRO | ||||||||
FirstName: | LAWRENCE | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2001 SANTA MONICA BLVD | ||||||||
Address2: | SUITE 560W | ||||||||
City: | SANTA MONICA | ||||||||
State: | CA | ||||||||
PostalCode: | 904042102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3105827900 | ||||||||
FaxNumber: | 3105827946 | ||||||||
Practice Location | |||||||||
Address1: | 2001 SANTA MONICA BLVD | ||||||||
Address2: | SUITE 560W | ||||||||
City: | SANTA MONICA | ||||||||
State: | CA | ||||||||
PostalCode: | 904042102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3105827900 | ||||||||
FaxNumber: | 3105827946 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2006 | ||||||||
LastUpdateDate: | 05/08/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | G52155 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | AP2684303 | 01 | CA | DEA- SM LOCATION | OTHER | W15185 | 01 | CA | MEDICARE PTAN - FACILITY | OTHER | BP8317910 | 01 | CA | DEA- LA LOCATION | OTHER | G52155 | 01 | CA | MEDICAL LICENSE | OTHER | W15185A | 01 | CA | MEDICARE PTAN - FACILITY | OTHER |