Provider Demographics
NPI:1174802698
Name:GILLAN, LAUREN RAE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:GILLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RAE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5018
Mailing Address - Country:US
Mailing Address - Phone:562-869-1201
Mailing Address - Fax:562-869-1281
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant