Provider Demographics
NPI:1699959080
Name:LONDON, LAWANA
Entity type:Individual
Prefix:MS
First Name:LAWANA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 CENTER AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4674
Mailing Address - Country:US
Mailing Address - Phone:510-307-4404
Mailing Address - Fax:925-313-6198
Practice Address - Street 1:597 CENTER AVE STE 150
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4674
Practice Address - Country:US
Practice Address - Phone:510-307-4404
Practice Address - Fax:925-313-6198
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator