Healthcare Provider Details

I. General information

NPI: 1548948102
Provider Name (Legal Business Name): LAURA JEAN LAMBE X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PAUL DR
SAN RAFAEL CA
94903-2023
US

IV. Provider business mailing address

135 PAUL DR
SAN RAFAEL CA
94903-2023
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-4444
  • Fax: 415-492-8844
Mailing address:
  • Phone: 415-492-4444
  • Fax: 415-492-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: