Provider Demographics
NPI:1497494348
Name:MAGDALENO, LAUREN ALICE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALICE
Last Name:MAGDALENO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W IMPERIAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3812
Mailing Address - Country:US
Mailing Address - Phone:714-449-6900
Mailing Address - Fax:
Practice Address - Street 1:955 W IMPERIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3812
Practice Address - Country:US
Practice Address - Phone:714-449-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant