Individual
LAURIE LYNN LAVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6315A JAHNKE RD, RICHMOND, VA 23225-4142
(562) 677-2414
Mailing address
12900 PARK PLAZA DR STE 150, CERRITOS, CA 90703-9329
(562) 677-2414
(562) 741-4479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101243925
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0101243925
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275507402
—
VA
Enumeration date
02/15/2006
Last updated
01/22/2020
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