Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95012799 | CA |
NPI | 1023652666 |
---|---|
Provider Name | Lauren Scarponi |
First Address | San Clemente, CA 92673-5639 |
Second Address | Riverside, CA 92501-4135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2019 |
Last Update Date | 06/11/2019 |