MEDICARE: MR. JAMES VICTOR LYNCH III PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	58535	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1235747866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES VICTOR LYNCH III PA

Provider Business Mailing Address
First Line	:	910 HALE PL STE 102
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-3598
Country	:	US
Telephone Number	:	916-595-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 HALE PL STE 102
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-3598
Country	:	US
Telephone Number	:	619-625-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	01/15/2025

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