Healthcare Provider Details

I. General information

NPI: 1871265090
Provider Name (Legal Business Name): LAUREN SCANDURA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD STE 200
LOS ALAMOS NM
87544-5301
US

IV. Provider business mailing address

1500 N RENAISSANCE BLVD NE STE C
ALBUQUERQUE NM
87107-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-4147
  • Fax: 866-913-0013
Mailing address:
  • Phone: 505-266-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2023-0214
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: