Healthcare Provider Details

I. General information

NPI: 1295439644
Provider Name (Legal Business Name): KATRINA LAMBETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 JACKMAN ST
EL CAJON CA
92020-3053
US

IV. Provider business mailing address

844 JACKMAN ST
EL CAJON CA
92020-3053
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-2560
  • Fax: 619-442-7836
Mailing address:
  • Phone: 619-442-2560
  • Fax: 619-442-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number198083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: