Healthcare Provider Details

I. General information

NPI: 1508093543
Provider Name (Legal Business Name): LAUREN H. GRAWERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25745 BARTON RD STE 414
LOMA LINDA CA
92354-3812
US

IV. Provider business mailing address

4995 BRADENTON AVE STE 130
DUBLIN OH
43017-3551
US

V. Phone/Fax

Practice location:
  • Phone: 909-567-2527
  • Fax: 909-415-2373
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD479841
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101256048
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC177679
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number333538
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31739
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: