Provider Demographics
NPI:1083698245
Name:LAUERMAN, JAMES A (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LAUERMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25495 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4902
Mailing Address - Country:US
Mailing Address - Phone:951-506-9536
Mailing Address - Fax:951-693-4631
Practice Address - Street 1:25495 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4902
Practice Address - Country:US
Practice Address - Phone:951-506-9536
Practice Address - Fax:951-693-4631
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30228ZOtherCMS GRP ID
CAZZZ30228ZOtherCMS GRP ID
CAML1099591OtherDEA
CAQ04353Medicare UPIN