Healthcare Provider Details

I. General information

NPI: 1043997257
Provider Name (Legal Business Name): LAUREN NICOLE DEWIGGINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 KATELLA AVE STE 202
LOS ALAMITOS CA
90720-3497
US

IV. Provider business mailing address

3851 KATELLA AVE STE 202
LOS ALAMITOS CA
90720-3497
US

V. Phone/Fax

Practice location:
  • Phone: 562-206-0177
  • Fax:
Mailing address:
  • Phone: 562-206-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65496
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: