Healthcare Provider Details

I. General information

NPI: 1710143086
Provider Name (Legal Business Name): LYNN WARNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 07/22/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE STE 800
SAN DIEGO CA
92117-6970
US

IV. Provider business mailing address

4040 HANCOCK ST APT 1006
SAN DIEGO CA
92110-5112
US

V. Phone/Fax

Practice location:
  • Phone: 757-870-7577
  • Fax:
Mailing address:
  • Phone: 757-870-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: