Healthcare Provider Details

I. General information

NPI: 1154875672
Provider Name (Legal Business Name): LAUREN CARTWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HEGENBERGER RD SUITE 100
OAKLAND CA
94621-1448
US

IV. Provider business mailing address

1375 SYCAMORE AVE APT 362
HERCULES CA
94547-5509
US

V. Phone/Fax

Practice location:
  • Phone: 510-430-2500
  • Fax: 510-430-2549
Mailing address:
  • Phone: 405-413-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO005636
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: