Healthcare Provider Details

I. General information

NPI: 1982115077
Provider Name (Legal Business Name): ANNE ELIZABETH LAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTERN AVE STE 305
SAN BERNARDINO CA
92411-1354
US

IV. Provider business mailing address

1800 WESTERN AVE STE 305
SAN BERNARDINO CA
92411-1354
US

V. Phone/Fax

Practice location:
  • Phone: 909-880-9993
  • Fax: 909-880-9998
Mailing address:
  • Phone: 909-880-9993
  • Fax: 909-880-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: