Healthcare Provider Details

I. General information

NPI: 1285153411
Provider Name (Legal Business Name): MISS LAUREN TAYLOR RONQUILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 RONSON CT STE 207
SAN DIEGO CA
92111-1805
US

IV. Provider business mailing address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

V. Phone/Fax

Practice location:
  • Phone: 844-737-3638
  • Fax:
Mailing address:
  • Phone: 661-868-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: