Provider Demographics
NPI:1245828953
Name:KAWAGUCHI, LAUREN COLLEEN (RN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:COLLEEN
Last Name:KAWAGUCHI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:COLLEEN
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5674 WINDSOR WAY UNIT 109
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6785
Mailing Address - Country:US
Mailing Address - Phone:818-943-4252
Mailing Address - Fax:
Practice Address - Street 1:5674 WINDSOR WAY UNIT 109
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6785
Practice Address - Country:US
Practice Address - Phone:818-943-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95229943163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice