Healthcare Provider Details

I. General information

NPI: 1962048801
Provider Name (Legal Business Name): LAUREN ELIZABETH MCILROY-DEGETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 JACKSON ST
HAYWARD CA
94544-1530
US

IV. Provider business mailing address

409 JACKSON ST
HAYWARD CA
94544-1530
US

V. Phone/Fax

Practice location:
  • Phone: 510-891-5600
  • Fax:
Mailing address:
  • Phone: 510-891-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: