Healthcare Provider Details

I. General information

NPI: 1225804891
Provider Name (Legal Business Name): LAUREN MARY CAPALONGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARY DUTHIE PA-C

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 335
NEWPORT BEACH CA
92663-3672
US

IV. Provider business mailing address

104 WHITE CAP LN
NEWPORT COAST CA
92657-1086
US

V. Phone/Fax

Practice location:
  • Phone: 949-236-7900
  • Fax:
Mailing address:
  • Phone: 607-351-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66167
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number03110801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: