Provider Demographics
NPI:1194258780
Name:AUSAMA, LAUREN DANIELLE
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:DANIELLE
Last Name:AUSAMA
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 1:1222 N BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4173
Mailing Address - Country:US
Mailing Address - Phone:214-941-1353
Mailing Address - Fax:214-941-1047
Practice Address - Street 1:1222 N BISHOP AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4176
Practice Address - Country:US
Practice Address - Phone:214-941-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TXS2553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program