Provider Demographics
NPI:1841408390
Name:LOWRY, LAURA M (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:NULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E VALENCIA MESA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3817
Mailing Address - Country:US
Mailing Address - Phone:714-446-5050
Mailing Address - Fax:714-446-5150
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-446-5050
Practice Address - Fax:714-446-5150
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18610OtherLICENSE