Provider Demographics
NPI:1154971026
Name:LAUZON, MEGAN FRANCES SALVANA
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:FRANCES SALVANA
Last Name:LAUZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 PYRAMID CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6650
Mailing Address - Country:US
Mailing Address - Phone:707-290-1473
Mailing Address - Fax:
Practice Address - Street 1:2000 EMBARCADERO STE 400
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5300
Practice Address - Country:US
Practice Address - Phone:510-567-8101
Practice Address - Fax:510-567-6850
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38168390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty