Healthcare Provider Details

I. General information

NPI: 1407393044
Provider Name (Legal Business Name): LAUREN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 SEPULVEDA BLVD
VAN NUYS CA
91405-2003
US

IV. Provider business mailing address

7226 SEPULVEDA BLVD
VAN NUYS CA
91405-2003
US

V. Phone/Fax

Practice location:
  • Phone: 818-235-1414
  • Fax: 818-948-0827
Mailing address:
  • Phone: 818-235-1414
  • Fax: 818-948-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: