Healthcare Provider Details

I. General information

NPI: 1427224161
Provider Name (Legal Business Name): LISA KAY LAWITZKE-HUNDLEY IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35000 GUADALCANAL AVE BLDG 596
SAN DIEGO CA
92140-5599
US

IV. Provider business mailing address

4770 PICO ST
SAN DIEGO CA
92109-3808
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-8311
  • Fax:
Mailing address:
  • Phone: 224-627-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: