Healthcare Provider Details

I. General information

NPI: 1235093295
Provider Name (Legal Business Name): CHISOM LYNDA PIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 HAAS AVE APT 12
SAN LEANDRO CA
94577-3742
US

IV. Provider business mailing address

236 HAAS AVE APT 12
SAN LEANDRO CA
94577-3742
US

V. Phone/Fax

Practice location:
  • Phone: 510-707-1406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: