Provider Demographics
NPI:1205208394
Name:SPRINGER, ALBERT LAMONT
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:LAMONT
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 BEAR VALLEY RD STE 10517330
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7741
Mailing Address - Country:US
Mailing Address - Phone:760-493-1191
Mailing Address - Fax:760-947-3673
Practice Address - Street 1:16455 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3550
Practice Address - Country:US
Practice Address - Phone:760-947-2161
Practice Address - Fax:760-947-3673
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002116363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care