Healthcare Provider Details

I. General information

NPI: 1760824833
Provider Name (Legal Business Name): CECIL O LYNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 COUNTRYWOODS LANE
GRANITE BAY CA
95746
US

IV. Provider business mailing address

6500 COUNTRYWOODS LN
GRANITE BAY CA
95746-9639
US

V. Phone/Fax

Practice location:
  • Phone: 916-412-5504
  • Fax: 916-797-2567
Mailing address:
  • Phone: 916-412-5504
  • Fax: 916-797-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG61610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: