Healthcare Provider Details

I. General information

NPI: 1124474549
Provider Name (Legal Business Name): LYNN MARIE MCALISTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SUTTER PL
DAVIS CA
95616-6201
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-5226
  • Fax:
Mailing address:
  • Phone: 510-869-6883
  • Fax: 510-869-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A17222
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12042
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A17222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: