Healthcare Provider Details

I. General information

NPI: 1962027706
Provider Name (Legal Business Name): LAUREN SYLWESTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST STE 2100
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

18035 BROOKHURST ST STE 2100
FOUNTAIN VALLEY CA
92708-6738
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-9090
  • Fax: 714-665-4603
Mailing address:
  • Phone: 657-241-9090
  • Fax: 714-665-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: