Provider Demographics
NPI:1043301344
Name:FISHER, LYNDA KAREN (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:KAREN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MS# 61
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-4606
Mailing Address - Fax:323-361-1350
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MS# 61
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-4606
Practice Address - Fax:323-664-0337
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG235662080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G235660Medicaid
CA00G235660Medicaid
CAA41997Medicare UPIN