Provider Demographics
NPI:1346255122
Name:FOSSATTI, LINDSAY J
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:J
Last Name:FOSSATTI
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 1:22032 EL PASEO
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3947
Mailing Address - Country:US
Mailing Address - Phone:949-766-8535
Mailing Address - Fax:949-766-8540
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 210
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3947
Practice Address - Country:US
Practice Address - Phone:949-766-8535
Practice Address - Fax:949-766-8540
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist