Provider Demographics
NPI:1477818938
Name:KELLER, LAUREN P (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:P
Last Name:KELLER
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 1:1495 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4517
Mailing Address - Country:US
Mailing Address - Phone:916-925-7020
Mailing Address - Fax:916-925-3680
Practice Address - Street 1:1495 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4517
Practice Address - Country:US
Practice Address - Phone:916-925-7020
Practice Address - Fax:916-925-3680
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3194207N00000X
CA20A13001207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology