Healthcare Provider Details

I. General information

NPI: 1801823547
Provider Name (Legal Business Name): LYNN K. MCLEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST STE 3400
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST STE 3400
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4771
  • Fax:
Mailing address:
  • Phone: 909-558-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG074058
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberG74058
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG74058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: