Healthcare Provider Details

I. General information

NPI: 1811794696
Provider Name (Legal Business Name): LAUREN SMART MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 VILLAGE CENTER LOOP RD
SAN DIEGO CA
92130-2499
US

IV. Provider business mailing address

946 OPAL ST APT 1
SAN DIEGO CA
92109-1842
US

V. Phone/Fax

Practice location:
  • Phone: 858-350-0253
  • Fax:
Mailing address:
  • Phone: 415-747-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000060291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: