Healthcare Provider Details

I. General information

NPI: 1023105335
Provider Name (Legal Business Name): LAUREN GIST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST. SUITE 360
SAN DIEGO CA
92123-2776
US

IV. Provider business mailing address

3880 MURPHY CANYON RD. SUITE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 858-246-0053
  • Fax: 858-496-9257
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA81381
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA81381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: