Provider Demographics
NPI:1194920728
Name:LAGUNA WOODS SENIOR MEDICAL GROUP
Entity type:Organization
Organization Name:LAGUNA WOODS SENIOR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-707-1807
Mailing Address - Street 1:24331 EL TORO RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2752
Mailing Address - Country:US
Mailing Address - Phone:949-707-1807
Mailing Address - Fax:949-707-1874
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:SUITE 330
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:949-707-1807
Practice Address - Fax:949-707-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty