Provider Demographics
NPI:1194345116
Name:WHEELER, LAUREN MAMARIL (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MAMARIL
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SANTILLAN
Other - Last Name:MAMARIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8078 E SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1108
Mailing Address - Country:US
Mailing Address - Phone:714-974-2900
Mailing Address - Fax:
Practice Address - Street 1:8078 E SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1108
Practice Address - Country:US
Practice Address - Phone:714-974-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A20180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine