Provider Demographics
NPI:1356620983
Name:KISCADEN, LAUREN L (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:KISCADEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26726 CROWN VALLEY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8003
Mailing Address - Country:US
Mailing Address - Phone:949-364-4361
Mailing Address - Fax:949-364-4495
Practice Address - Street 1:26726 CROWN VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8003
Practice Address - Country:US
Practice Address - Phone:949-364-4361
Practice Address - Fax:949-364-4495
Is Sole Proprietor?:No
Enumeration Date:2011-08-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant