Provider Demographics
NPI:1023112315
Name:LAUREN L REAGER A CALIFORNIA MEDICAL CORPORATION
Entity type:Organization
Organization Name:LAUREN L REAGER A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-4484
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 990W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2155
Mailing Address - Country:US
Mailing Address - Phone:310-829-4484
Mailing Address - Fax:310-829-4481
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 990W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2155
Practice Address - Country:US
Practice Address - Phone:310-829-4484
Practice Address - Fax:310-828-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8759Medicare UPIN