Healthcare Provider Details

I. General information

NPI: 1730612532
Provider Name (Legal Business Name): LAUREN EILLEN MACARAEG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SOUTHGATE AVE # 102
DALY CITY CA
94015-4015
US

IV. Provider business mailing address

1498 SOUTHGATE AVE # 102
DALY CITY CA
94015-4015
US

V. Phone/Fax

Practice location:
  • Phone: 650-755-4490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA164350
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA164350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: