Provider Demographics
NPI:1821289265
Name:ADAMS, LAUREN WALTERS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:WALTERS
Last Name:ADAMS
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 1:2507 EASTBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3504
Mailing Address - Country:US
Mailing Address - Phone:949-200-1655
Mailing Address - Fax:
Practice Address - Street 1:2507 EASTBLUFF DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3504
Practice Address - Country:US
Practice Address - Phone:949-200-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05281363A00000X
CAPA21103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L24316Medicare PIN