Provider Demographics
NPI:1760647853
Name:SWANSON, LAUREN N (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:SWANSON
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 1:1198 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6251
Mailing Address - Country:US
Mailing Address - Phone:562-799-7071
Mailing Address - Fax:562-594-5627
Practice Address - Street 1:1198 PACIFIC COAST HWY
Practice Address - Street 2:SUITE I
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6251
Practice Address - Country:US
Practice Address - Phone:562-799-7071
Practice Address - Fax:562-594-5627
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01391224OtherRR MEDICARE
CAP01391224OtherRR MEDICARE