Provider Demographics
NPI:1457647901
Name:DAVIS, LAUREN KENT (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KENT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7373
Mailing Address - Country:US
Mailing Address - Phone:949-643-0500
Mailing Address - Fax:949-643-3748
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7373
Practice Address - Country:US
Practice Address - Phone:949-643-0500
Practice Address - Fax:949-643-3748
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB215490Medicare UPIN