Provider Demographics
NPI:1609161439
Name:STARK, LAUREN E (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:STARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:BRAATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39350 CIVIC CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2331
Mailing Address - Country:US
Mailing Address - Phone:510-797-3933
Mailing Address - Fax:510-797-5184
Practice Address - Street 1:39350 CIVIC CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2331
Practice Address - Country:US
Practice Address - Phone:510-797-3933
Practice Address - Fax:510-797-5184
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21523363A00000X
CAPA21523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant