1033123385 NPI number — LAUREN ELIZABETH BEAUCHAMP PH.D.

Table of content: LAUREN ELIZABETH BEAUCHAMP PH.D. (NPI 1033123385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033123385 NPI number — LAUREN ELIZABETH BEAUCHAMP PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUCHAMP
Provider First Name:
LAUREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033123385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2452 FENTON ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91914-3599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-279-1223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3325 GREYSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMUL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91935-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-588-2680
Provider Business Practice Location Address Fax Number:
858-467-6933
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY19559 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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