Individual
MS. LAUREN MARIKO OHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
Mailing address
2575 MARIGOLD CIR, CORONA, CA 92881-3664
(951) 279-9463
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT 38449
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT38449
PT LICENSE
CA
Enumeration date
03/15/2012
Last updated
03/15/2012
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