Provider Demographics
NPI:1184018442
Name:APPLE, LYDIA IDELLA
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:IDELLA
Last Name:APPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 FAIRMONT DR
Mailing Address - Street 2:EDEN CSC
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1088
Mailing Address - Country:US
Mailing Address - Phone:510-667-7500
Mailing Address - Fax:
Practice Address - Street 1:2045 FAIRMONT DR
Practice Address - Street 2:EDEN CSC
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1088
Practice Address - Country:US
Practice Address - Phone:510-667-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program