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General NPI Number Information
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NPI Number | 1679171896
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Entity Type | Individual
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Provider Name | LAUREN ANNE MAAG PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 9900 TALBERT AVE STE 103A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5153
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Country | US
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Telephone | 657-259-0050
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Fax | 657-244-8019
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Provider Business Mailing Address
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Address Line | 16602 GRAHAM PL
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3619
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Country | US
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Telephone | 209-470-6607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA58654
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License Number State | CA
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