Healthcare Provider Details

I. General information

NPI: 1043108814
Provider Name (Legal Business Name): MR. THOMAS MATHEW LAMBDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 COLOMA ST
PLACERVILLE CA
95667-4406
US

IV. Provider business mailing address

PO BOX 871
GARDEN VALLEY CA
95633-0871
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-9240
  • Fax: 530-642-2064
Mailing address:
  • Phone: 530-333-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: