Provider Demographics
NPI:1356590210
Name:MARTIN, LAUREN T
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CANTERBURY DR APT C104
Mailing Address - Street 2:5950 CANTERBURY DRIVE #C104
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6715
Mailing Address - Country:US
Mailing Address - Phone:310-641-8318
Mailing Address - Fax:
Practice Address - Street 1:5950 CANTERBURY DR APT C104
Practice Address - Street 2:5950 CANTERBURY DRIVE #C104
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6715
Practice Address - Country:US
Practice Address - Phone:310-641-8318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner