Healthcare Provider Details

I. General information

NPI: 1619235827
Provider Name (Legal Business Name): LAUREN ASHLEY NELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 OWENS DR
PLEASANTON CA
94588
US

IV. Provider business mailing address

5860 OWENS DR
PLEASANTON CA
94588-3980
US

V. Phone/Fax

Practice location:
  • Phone: 252-240-0770
  • Fax:
Mailing address:
  • Phone: 925-224-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA127891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: