Healthcare Provider Details

I. General information

NPI: 1023382074
Provider Name (Legal Business Name): LAUREN CURLEY EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

PO BOX 230760
ENCINITAS CA
92023-0760
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-2251
  • Fax:
Mailing address:
  • Phone: 760-230-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 52589
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 52589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: