Provider Demographics
NPI:1053484568
Name:ASSELIN, LYNETTE M (DO)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:ASSELIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2068 W VISTA WAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6010
Mailing Address - Country:US
Mailing Address - Phone:760-941-3630
Mailing Address - Fax:760-941-1214
Practice Address - Street 1:2067 W VISTA WAY STE 280
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6034
Practice Address - Country:US
Practice Address - Phone:760-941-3630
Practice Address - Fax:760-941-1214
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45689Medicare UPIN
CAW14833AMedicare PIN