Healthcare Provider Details

I. General information

NPI: 1760488621
Provider Name (Legal Business Name): MARC E. LYNCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5365 WALNUT AVE STE P
CHINO CA
91710-2622
US

IV. Provider business mailing address

PO BOX 2492
RANCHO CUCAMONGA CA
91729-2492
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-0843
  • Fax: 909-591-7226
Mailing address:
  • Phone: 909-591-0843
  • Fax: 909-591-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A6261
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A6261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: