Healthcare Provider Details

I. General information

NPI: 1780421198
Provider Name (Legal Business Name): LAUREN MARIE BESERRA CNM/WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 04/23/2025
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 N SKYTOP CT
ORANGE CA
92867-6492
US

IV. Provider business mailing address

2563 N SKYTOP CT
ORANGE CA
92867-6492
US

V. Phone/Fax

Practice location:
  • Phone: 702-423-8707
  • Fax:
Mailing address:
  • Phone: 702-423-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95031082
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: