Individual
DR. LAWRENCE DALE MCNUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18436 ROSCOE BLVD, NORTHRIDGE, CA 91325-4107
(818) 435-1800
(818) 435-1490
Mailing address
7521 EDINGER AVE UNIT 4245, HUNTINGTON BEACH, CA 92647-0610
(714) 655-9779
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
A83196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A83196
MEDICAL LICENSE
CA
Enumeration date
06/12/2007
Last updated
12/05/2014
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