Provider Demographics
NPI:1073163390
Name:WAKABAYASHI, LAUREN EMILY TAYE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:EMILY TAYE
Last Name:WAKABAYASHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARBOR-UCLA DMH
Mailing Address - Street 2:1000 W CARSON ST BOX #498
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HARBOR-UCLA DMH
Practice Address - Street 2:1000 W CARSON ST BOX #498
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:91030
Practice Address - Country:US
Practice Address - Phone:424-306-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program