Provider Demographics
NPI:1265696298
Name:FANNING, LAUREN E (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:FANNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:19066 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2232
Mailing Address - Country:US
Mailing Address - Phone:714-968-0068
Mailing Address - Fax:714-378-2188
Practice Address - Street 1:19066 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2232
Practice Address - Country:US
Practice Address - Phone:714-968-0068
Practice Address - Fax:714-378-2188
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA126066208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology