Healthcare Provider Details

I. General information

NPI: 1427691567
Provider Name (Legal Business Name): OPHELIA RAYCHELLE LINDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14124 PRAIRIE AVE
HAWTHORNE CA
90250-7906
US

IV. Provider business mailing address

4781 N POLK AVE APT 195
FRESNO CA
93722-5344
US

V. Phone/Fax

Practice location:
  • Phone: 682-344-5600
  • Fax:
Mailing address:
  • Phone: 951-380-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-101910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: