Healthcare Provider Details

I. General information

NPI: 1396805370
Provider Name (Legal Business Name): LINDSAY LAETSCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD
SAN DIEGO CA
92110-3889
US

IV. Provider business mailing address

1260 MORENA BLVD
SAN DIEGO CA
92110-3889
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-0355
  • Fax: 619-398-0350
Mailing address:
  • Phone: 619-398-0355
  • Fax: 619-398-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number770389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: