MEDICARE: MRS. LAUREN SAMUELS

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	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1922993955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN SAMUELS

Provider Business Mailing Address
First Line	:	4660 LA JOLLA VILLAGE DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 LA JOLLA VILLAGE DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4604
Country	:	US
Telephone Number	:	858-752-3094
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ MRS. LAUREN SAMUELS ” Practice Location

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