Provider Demographics
NPI:1154569598
Name:SACKS, LAUREN JUDITH (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JUDITH
Last Name:SACKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2418
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:
Practice Address - Street 1:2100 MONUMENT BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3489
Practice Address - Country:US
Practice Address - Phone:925-363-2000
Practice Address - Fax:925-363-2006
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP18576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily