Healthcare Provider Details

I. General information

NPI: 1124590583
Provider Name (Legal Business Name): LYNN BARBARA MURPHY MA/CCC/SP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17647 POMERADO RD UNIT 138
SAN DIEGO CA
92128-1661
US

IV. Provider business mailing address

17647 POMERADO RD UNIT 138
SAN DIEGO CA
92128-1661
US

V. Phone/Fax

Practice location:
  • Phone: 916-768-2690
  • Fax:
Mailing address:
  • Phone: 916-768-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberSP6825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP6825
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberSP6825
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number6825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: