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General NPI Number Information
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NPI Number | 1073489209
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Entity Type | Individual
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Provider Name | ELISE LAKIN
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Gender | Female
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 4155 GEORGIA ST APT 201
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City | SAN DIEGO
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State | CA
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Zip | 92103-2532
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Country | US
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Telephone | 970-380-0984
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Fax |
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Provider Business Mailing Address
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Address Line | 4155 GEORGIA ST APT 201
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City | SAN DIEGO
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State | CA
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Zip | 92103-2532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 28142
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License Number State | CA
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