Provider Demographics
NPI:1831648435
Name:PAPANOS, LAUREN ATHENA (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ATHENA
Last Name:PAPANOS
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23442 BATEY AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1204
Mailing Address - Country:US
Mailing Address - Phone:619-379-2416
Mailing Address - Fax:
Practice Address - Street 1:886 SINGING TRAILS DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2756
Practice Address - Country:US
Practice Address - Phone:619-379-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84413133V00000X
CA86038027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherUNITED HEALTHCARE
258298OtherHEALTH NET
CA0000OtherANTHEM BC OF CA