Provider Demographics
NPI:1275686693
Name:CHAMBERS, LYNNE LORRAINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:LORRAINE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:LYNNE
Other - Middle Name:LORRAINE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1212 LOMA DR
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3814
Mailing Address - Country:US
Mailing Address - Phone:310-257-6183
Mailing Address - Fax:
Practice Address - Street 1:25965 SOUTH NORMANDIE AVE
Practice Address - Street 2:PEDIATRICS 2ND FLOOR
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:310-257-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 12232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant