Healthcare Provider Details

I. General information

NPI: 1982019485
Provider Name (Legal Business Name): JEREMY LAMPEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BAY AVE
CAPITOLA CA
95010-2186
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-460-7333
  • Fax:
Mailing address:
  • Phone: 831-479-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number995259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: