Healthcare Provider Details

I. General information

NPI: 1861105116
Provider Name (Legal Business Name): LAUREN NEWSOME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 CRAVEN ST # 3300
SAN DIEGO CA
92136-2575
US

IV. Provider business mailing address

3622 INDIANA ST APT 103
SAN DIEGO CA
92103-7503
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-5191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number199053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: