Provider Demographics
NPI:1093459620
Name:REYNER, LAUREN (STUDENT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:REYNER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:REYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT
Mailing Address - Street 1:25 OAKBROOK
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4741
Mailing Address - Country:US
Mailing Address - Phone:949-910-4502
Mailing Address - Fax:
Practice Address - Street 1:2575 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1699
Practice Address - Country:US
Practice Address - Phone:949-910-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program