Healthcare Provider Details

I. General information

NPI: 1780918433
Provider Name (Legal Business Name): DEADRA LAMPKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914155 LIBERTY ST SUITE A110
FREMONT CA
94538
US

IV. Provider business mailing address

1103 CARLTON AVE
MENLO PARK CA
94025-1601
US

V. Phone/Fax

Practice location:
  • Phone: 510-574-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: