MEDICARE: LIGHTBRIDGE MEDICAL ASSOCIATES, INC.

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CY415A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1689901068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTBRIDGE MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	6155 CORNERSTONE CT E
Second Line	:	SUITE #220
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4737
Country	:	US
Telephone Number	:	858-458-2992
Fax Number	:	858-362-4027

Provider Business Practice Location Address
First Line	:	6155 CORNERSTONE CT E
Second Line	:	SUITE #220
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4737
Country	:	US
Telephone Number	:	858-458-2992
Fax Number	:	858-362-4027

Authorized Official
Title or Position	:	CONTROLLER
Name	:	CINDY CAMERON
Credential	:
Telephone Number	:	858-458-2992

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	01/04/2012

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