Healthcare Provider Details

I. General information

NPI: 1932688074
Provider Name (Legal Business Name): LAMIA EAP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S DELAWARE ST STE 130
SAN MATEO CA
94403-2394
US

IV. Provider business mailing address

16242 DAWN WAY
TUSTIN CA
92782-2857
US

V. Phone/Fax

Practice location:
  • Phone: 573-825-1030
  • Fax:
Mailing address:
  • Phone: 573-825-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: