MEDICARE: LAUREN GIST M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	A81381	CA
2	208000000X	Pediatrics Physician	A81381	CA

General Provider Information

NPI Number	:	1023105335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GIST M.D.

Provider Business Mailing Address
First Line	:	3880 MURPHY CANYON RD.
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4411
Country	:	US
Telephone Number	:	858-636-4300
Fax Number	:	858-636-4319

Provider Business Practice Location Address
First Line	:	7910 FROST ST.
Second Line	:	SUITE 360
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2776
Country	:	US
Telephone Number	:	858-246-0053
Fax Number	:	858-496-9257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/31/2025

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Directions to “ LAUREN GIST M.D.” Practice Location

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