Healthcare Provider Details

I. General information

NPI: 1407817570
Provider Name (Legal Business Name): TRACY LUMSDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST ST
SACRAMENTO CA
95814-5216
US

IV. Provider business mailing address

5501 BROME CT
ORANGEVALE CA
95662-5329
US

V. Phone/Fax

Practice location:
  • Phone: 916-914-6319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberPA 137237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: