MEDICARE: LAUREN SLAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-143089	CA
2	176B00000X	Midwife	LM431	CA

General Provider Information

NPI Number	:	1326465675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN SLAK

Provider Business Mailing Address
First Line	:	1616 CALLE LAS BOLAS
Second Line	:	APT D
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4909
Country	:	US
Telephone Number	:	808-896-2629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 CALLE LAS BOLAS
Second Line	:	APT D
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4909
Country	:	US
Telephone Number	:	808-896-2629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	10/10/2022

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Directions to “ LAUREN SLAK ” Practice Location

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