Healthcare Provider Details

I. General information

NPI: 1013315704
Provider Name (Legal Business Name): LAUREN MICHELLE PAOLI B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W BROADWAY SUITE 5010
LONG BEACH CA
90802-4431
US

IV. Provider business mailing address

617 N PINE PL
ANAHEIM CA
92805-2501
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-1330
  • Fax: 562-263-3395
Mailing address:
  • Phone: 714-341-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: