Healthcare Provider Details

I. General information

NPI: 1932430246
Provider Name (Legal Business Name): MICHAEL ANTHONY LAMONT IMF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL LAMONT IMF

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6342
US

IV. Provider business mailing address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6342
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-9676
  • Fax: 818-279-0377
Mailing address:
  • Phone: 858-279-9676
  • Fax: 858-279-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF # 56004
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 56004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: