Provider Demographics
NPI:1417352345
Name:BALBAS, LAUREN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BALBAS
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27995 GREENFIELD DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4432
Mailing Address - Country:US
Mailing Address - Phone:949-360-4400
Mailing Address - Fax:
Practice Address - Street 1:27995 GREENFIELD DR STE C
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4432
Practice Address - Country:US
Practice Address - Phone:949-360-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant