Healthcare Provider Details

I. General information

NPI: 1265889471
Provider Name (Legal Business Name): LAUREN SPADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8743
  • Fax:
Mailing address:
  • Phone: 562-933-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA151040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: