Healthcare Provider Details

I. General information

NPI: 1861753303
Provider Name (Legal Business Name): LAUREN TABILA LAUGHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN NICOLE TABILA MD

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 07/07/2023
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-3986
  • Fax: 951-353-5838
Mailing address:
  • Phone: 951-353-3986
  • Fax: 951-353-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA136600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME122310
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME122310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: