Healthcare Provider Details

I. General information

NPI: 1679597215
Provider Name (Legal Business Name): JANET LORD MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 TELEGRAPH AVE SUITE 241
BERKELEY CA
94705
US

IV. Provider business mailing address

3031 TELEGRAPH AVENUE SUITE 241
BERKELEY CA
94705-2052
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-2038
  • Fax: 510-549-2690
Mailing address:
  • Phone: 510-549-2038
  • Fax: 510-549-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberG40776
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JANET PHYLLIS LORD
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 510-549-2038