Provider Demographics
NPI:1225292055
Name:WELLS, LINDSAY KATHERINE
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:KATHERINE
Last Name:WELLS
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 1:2020 SANTA MONICA BLVD
Mailing Address - Street 2:210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2023
Mailing Address - Country:US
Mailing Address - Phone:310-582-6200
Mailing Address - Fax:310-260-2963
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:210
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2023
Practice Address - Country:US
Practice Address - Phone:310-582-6200
Practice Address - Fax:310-260-2963
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225292055Medicaid
CA1225292055OtherCCS PANELED
CAFW267YMedicare PIN