Healthcare Provider Details

I. General information

NPI: 1124979265
Provider Name (Legal Business Name): LAUREN MARIE GERON CMPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

IV. Provider business mailing address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4602
  • Fax:
Mailing address:
  • Phone: 951-358-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-AODXYE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: