Healthcare Provider Details

I. General information

NPI: 1811434467
Provider Name (Legal Business Name): MS. DEBORAH SUE LYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W. ARBOR DR. UCSD GIFFORD OUTPATIENT CLINIC
SAN DIEGO CA
92103-2421
US

IV. Provider business mailing address

140 W. ARBOR DR. UCSD GIFFORD OUTPATIENT CLINIC
SAN DIEGO CA
92103-2421
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6904
  • Fax: 619-543-7013
Mailing address:
  • Phone: 619-543-6904
  • Fax: 619-543-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: