Basic Information
| Provider Information | |||||||||
| NPI: | 1538105507 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSCH | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6655 LA JOLLA BLVD | ||||||||
| Address2: | #21 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920370003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583366601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3350 LA JOLLA VILLAGE DR | ||||||||
| Address2: | SUITE 126 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585527564 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 231H00000X | AU2219 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.