Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 20193 | CA |
NPI | 1073821724 |
---|---|
Provider Name | Lauren L. Pak |
First Address | Martinez, CA 94553-4640 |
Second Address | Martinez, CA 94553-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 12/12/2013 |