Provider Demographics
NPI:1700507290
Name:KOROKNAY, LAUREN (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KOROKNAY
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5472 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2231
Mailing Address - Country:US
Mailing Address - Phone:805-766-9175
Mailing Address - Fax:
Practice Address - Street 1:5472 HUNTER ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2231
Practice Address - Country:US
Practice Address - Phone:805-766-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2991772255A2300X
CA26766124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer