MEDICARE: MS. DEBORAH SUE LYNN

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	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1811434467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH SUE LYNN

Provider Business Mailing Address
First Line	:	140 W. ARBOR DR.
Second Line	:	UCSD GIFFORD OUTPATIENT CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2421
Country	:	US
Telephone Number	:	619-543-6904
Fax Number	:	619-543-7013

Provider Business Practice Location Address
First Line	:	140 W. ARBOR DR.
Second Line	:	UCSD GIFFORD OUTPATIENT CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2421
Country	:	US
Telephone Number	:	619-543-6904
Fax Number	:	619-543-7013

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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