Healthcare Provider Details

I. General information

NPI: 1992288153
Provider Name (Legal Business Name): LAUREN SPACIANO DO A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

PO BOX 691039
WEST HOLLYWOOD CA
90069-9039
US

V. Phone/Fax

Practice location:
  • Phone: 661-878-8150
  • Fax: 661-878-8551
Mailing address:
  • Phone: 661-878-8150
  • Fax: 661-878-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAUREN M SPACIANO
Title or Position: OWNER / PRESIDENT
Credential: DO
Phone: 661-878-8150