Healthcare Provider Details

I. General information

NPI: 1992463269
Provider Name (Legal Business Name): LAUREN ELIZABETH JUSTUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR STE 100
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

18466 JAYHAWK DR
PENN VALLEY CA
95946-9207
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax:
Mailing address:
  • Phone: 530-338-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: