Provider Demographics
NPI:1376780627
Name:LEMUS, JACQUELINE (DA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LEMUS
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2450
Mailing Address - Country:US
Mailing Address - Phone:626-964-1916
Mailing Address - Fax:
Practice Address - Street 1:4000 LA RICA AVE.
Practice Address - Street 2:STE. D
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706
Practice Address - Country:US
Practice Address - Phone:626-430-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant