Healthcare Provider Details

I. General information

NPI: 1962104273
Provider Name (Legal Business Name): LAUREN THERESE MANN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 CONVOY CT
SAN DIEGO CA
92111-1014
US

IV. Provider business mailing address

6911 CONVOY CT
SAN DIEGO CA
92111-1014
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax: 858-573-5613
Mailing address:
  • Phone: 833-574-2273
  • Fax: 858-573-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A23243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: