# RENEE LAURITZEN MD A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Orthopedics and Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770654378
- **Authorized official:** MRS. RENEE S LAURITZEN M.D. (DOCTOR)
- **Authorized official phone:** (805) 542-9678

## Contact information

- **Practice address:** 1500 PALM ST, SUITE A, SAN LUIS OBISPO, CA 93401-2998
- **Practice address phone:** (805) 542-9678
- **Practice address fax:** (805) 542-9685
- **Mailing address:** 1500 PALM ST, SUITE A, SAN LUIS OBISPO, CA 93401-2998
- **Mailing address phone:** (805) 542-9678
- **Mailing address fax:** (805) 542-9685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G77320 | CA | Yes |

## Other

- **Enumeration date:** 11/13/2006
- **Last updated:** 08/28/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00G773200 | BLUE SHIELD | CA |
| 01 | — | G77320 | BLUE CROSS | CA |