Provider Demographics
NPI:1831390103
Name:GREENBERG, LAURENCE FREDERIC (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:FREDERIC
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 VON KARMAN AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1539
Mailing Address - Country:US
Mailing Address - Phone:949-222-6662
Mailing Address - Fax:949-222-6667
Practice Address - Street 1:19100 VON KARMAN AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1539
Practice Address - Country:US
Practice Address - Phone:949-222-6662
Practice Address - Fax:949-222-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0663462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry