Healthcare Provider Details

I. General information

NPI: 1689493777
Provider Name (Legal Business Name): LAUREN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 LEEDS ST
DOWNEY CA
90242-3489
US

IV. Provider business mailing address

2234 N BELLFLOWER BLVD UNIT 15181
LONG BEACH CA
90815-7007
US

V. Phone/Fax

Practice location:
  • Phone: 562-445-3001
  • Fax:
Mailing address:
  • Phone: 562-257-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC17369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: