Provider Demographics
NPI:1619537370
Name:GANCAYCO, LAUREN (RPE-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GANCAYCO
Suffix:
Gender:F
Credentials:RPE-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 REDONDO BEACH BLVD APT 131
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1401
Mailing Address - Country:US
Mailing Address - Phone:714-875-8028
Mailing Address - Fax:
Practice Address - Street 1:4010 BARRANCA PKWY STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1721
Practice Address - Country:US
Practice Address - Phone:949-857-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXEK905514506OtherBLUE SHIELD OF CALIFORNIA