Provider Demographics
NPI:1528673704
Name:PERRY, LAUREN (LMT, ET)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMT, ET
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LAUREN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9960 JUDY DR APT 201
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9960 JUDY DR APT 201
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5294
Practice Address - Country:US
Practice Address - Phone:910-489-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist