Provider Demographics
NPI:1780199349
Name:CHAVEZ, LAUREN HEINZE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HEINZE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:CHRISTINE
Other - Last Name:HEINZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 504
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3665
Mailing Address - Country:US
Mailing Address - Phone:949-588-5800
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 504
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3665
Practice Address - Country:US
Practice Address - Phone:949-588-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant