Provider Demographics
NPI:1477761310
Name:OZBOLT, LAUREN BURR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BURR
Last Name:OZBOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16738 VIA LA COSTA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1957
Mailing Address - Country:US
Mailing Address - Phone:305-202-2100
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1023
Practice Address - Country:US
Practice Address - Phone:305-202-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1043092084P0804X
CAA1325832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry