Healthcare Provider Details

I. General information

NPI: 1265696298
Provider Name (Legal Business Name): LAUREN E FANNING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200F
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200F
NEWPORT BEACH CA
92663-3664
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-8979
  • Fax: 949-999-8970
Mailing address:
  • Phone: 949-999-8979
  • Fax: 949-999-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA126066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: