Provider Demographics
NPI:1679946040
Name:CAMPAGNA, LAUREN E (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 EVERTS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5221
Mailing Address - Country:US
Mailing Address - Phone:585-217-6382
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1541
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52878363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical