Healthcare Provider Details

I. General information

NPI: 1548773880
Provider Name (Legal Business Name): LAUREN KAZANJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SAN CLEMENTE DR STE 140
CORTE MADERA CA
94925-1244
US

IV. Provider business mailing address

750 LAS GALLINAS AVE STE 103
SAN RAFAEL CA
94903-3431
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-1567
  • Fax:
Mailing address:
  • Phone: 415-492-8888
  • Fax: 415-492-8582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number7998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: