Provider Demographics
NPI:1407903479
Name:PAGE, LORRAINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:R
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CABRILLO HWY S STE 100A
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1738
Mailing Address - Country:US
Mailing Address - Phone:650-712-7330
Mailing Address - Fax:650-726-9317
Practice Address - Street 1:225 CABRILLO HWY S STE 100A
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1738
Practice Address - Country:US
Practice Address - Phone:650-712-7330
Practice Address - Fax:650-726-9317
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G735691Medicare ID - Type Unspecified
CAF66810Medicare UPIN