Basic Information
| Provider Information | |||||||||
| NPI: | 1801161385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OHARA | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | MARIKO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2575 MARIGOLD CIR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928813664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512799463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6177 RIVER CREST DR STE A | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2012 | ||||||||
| LastUpdateDate: | 03/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT 38449 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | PT38449 | 01 | CA | PT LICENSE | OTHER |