Healthcare Provider Details

I. General information

NPI: 1982000816
Provider Name (Legal Business Name): MRS. LINDSAY MARIE WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 210
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR SUITE 210
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-5180
  • Fax: 619-740-5190
Mailing address:
  • Phone: 619-740-5180
  • Fax: 619-740-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95000566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: