Healthcare Provider Details

I. General information

NPI: 1538696232
Provider Name (Legal Business Name): LAUREN KRYSTAL FELDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

IV. Provider business mailing address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3175
  • Fax:
Mailing address:
  • Phone: 323-543-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: