Healthcare Provider Details

I. General information

NPI: 1164256855
Provider Name (Legal Business Name): LYDIA RHEE POON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 UNIVERSITY AVE STE 216
LA MESA CA
91942-0523
US

IV. Provider business mailing address

8575 SUMMERDALE RD APT 191
SAN DIEGO CA
92126-5458
US

V. Phone/Fax

Practice location:
  • Phone: 619-241-2309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number132169
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: