Provider Demographics
NPI:1386618841
Name:PEARL, LAURENCE B (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:B
Last Name:PEARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:510 SUPERIOR AVE STE 200G
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3664
Mailing Address - Country:US
Mailing Address - Phone:949-791-6767
Mailing Address - Fax:949-791-6768
Practice Address - Street 1:510 SUPERIOR AVE STE 200G
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3664
Practice Address - Country:US
Practice Address - Phone:949-791-6767
Practice Address - Fax:949-791-6768
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697830Medicaid
H03218Medicare UPIN
CA00A697830Medicaid