Healthcare Provider Details

I. General information

NPI: 1174006340
Provider Name (Legal Business Name): LAUREN DASU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E CHESTNUT AVE
SANTA ANA CA
92701-6322
US

IV. Provider business mailing address

1601 E CHESTNUT AVE
SANTA ANA CA
92701-6322
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number19042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: