Healthcare Provider Details

I. General information

NPI: 1902897564
Provider Name (Legal Business Name): CLARITA LOUISE LUMSDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 W BASE LINE ST #107
SAN BERNARDINO CA
92411-1736
US

IV. Provider business mailing address

1574 W BASE LINE ST #107
SAN BERNARDINO CA
92411-1736
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-1880
  • Fax: 909-386-1882
Mailing address:
  • Phone: 909-386-1880
  • Fax: 909-386-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: