Healthcare Provider Details

I. General information

NPI: 1235853714
Provider Name (Legal Business Name): LAUREN AMANDA WANG MPH, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 BAIRD AVE
RESEDA CA
91335-4150
US

IV. Provider business mailing address

1037 E PALMDALE BLVD
PALMDALE CA
93550-4745
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-5897
  • Fax:
Mailing address:
  • Phone: 818-996-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: