Healthcare Provider Details

I. General information

NPI: 1790451276
Provider Name (Legal Business Name): LAUREN MCCAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

IV. Provider business mailing address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-4400
  • Fax: 858-673-4499
Mailing address:
  • Phone: 858-673-4400
  • Fax: 858-673-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: