Provider Demographics
NPI:1235747866
Name:LYNCH, JAMES VICTOR III (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VICTOR
Last Name:LYNCH
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:932 CLEAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3310
Mailing Address - Country:US
Mailing Address - Phone:916-595-4048
Mailing Address - Fax:
Practice Address - Street 1:2452 FENTON ST STE 205
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4551
Practice Address - Country:US
Practice Address - Phone:619-271-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA58535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program