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Individual

LAORENCE WASSOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP-C

Contact information

Practice address
170 COLUMBUS AVE STE 110, SAN FRANCISCO, CA 94133-5160
(415) 965-8050
(415) 965-7678
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95014763
CA
363L00000X
Nurse Practitioner
Primary
AP61085325
WA
363LF0000X
Family Nurse Practitioner
95014763
CA

Other

Enumeration date
06/18/2020
Last updated
01/20/2026
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