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General NPI Number Information
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NPI Number | 1760097984
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Entity Type | Organization
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Legal Business Name | LAUREN A. POLIAKIN, M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 227 W JANSS RD STE 300
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1885
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Country | US
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Telephone | 805-497-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 227 W JANSS RD STE 300
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1885
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Country | US
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Telephone | 805-497-8820
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN A POLIAKIN
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Credential | MD
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Telephone | 805-497-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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