Healthcare Provider Details

I. General information

NPI: 1952005498
Provider Name (Legal Business Name): LAUREN DUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CHINO AVE STE 120
CHINO HILLS CA
91709-1294
US

IV. Provider business mailing address

1912 S JACARANDA ST UNIT 164
ANAHEIM CA
92805-8734
US

V. Phone/Fax

Practice location:
  • Phone: 909-313-5111
  • Fax:
Mailing address:
  • Phone: 724-875-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number195200498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: