Healthcare Provider Details

I. General information

NPI: 1326857483
Provider Name (Legal Business Name): LYNDEN G PRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SENTER RD
SAN JOSE CA
95111-1053
US

IV. Provider business mailing address

2450 SENTER RD
SAN JOSE CA
95111-1053
US

V. Phone/Fax

Practice location:
  • Phone: 510-453-0486
  • Fax:
Mailing address:
  • Phone: 510-453-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: