Basic Information
Provider Information
NPI: 1992187959
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAUW
FirstName: STEPHANIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14475 VIVA DR
Address2:  
City: EASTVALE
State: CA
PostalCode: 928801071
CountryCode: US
TelephoneNumber: 9098964204
FaxNumber:  
Practice Location
Address1: 12401 WASHINGTON BLVD
Address2:  
City: WHITTIER
State: CA
PostalCode: 906021006
CountryCode: US
TelephoneNumber: 5626980811
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2015
LastUpdateDate: 08/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207P00000XA146034CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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