Provider Demographics
NPI:1578928032
Name:MOLLOY, LAUREN
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S MELROSE DR APT 28
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7450
Mailing Address - Country:US
Mailing Address - Phone:517-512-3054
Mailing Address - Fax:
Practice Address - Street 1:1510 S MELROSE DR APT 28
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7450
Practice Address - Country:US
Practice Address - Phone:517-512-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3444133247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other