Provider Demographics
NPI:1154736494
Name:VAN SANT, LAUREN MARIE (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:VAN SANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:PULIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:772 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1651
Practice Address - Country:US
Practice Address - Phone:805-256-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT22802086S0127X, 2086S0127X
CA20A144492086S0127X
NM1154736494390200000X
NMA-2409-202086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program