Healthcare Provider Details

I. General information

NPI: 1235338930
Provider Name (Legal Business Name): LAUREN WARNER SIMMONS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD 06/116B
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

14639 LOS FUENTES RD
LA MIRADA CA
90638-4355
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-478-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY20593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: