Provider Demographics
NPI:1427224161
Name:LAWITZKE-HUNDLEY, LISA KAY (IDC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:LAWITZKE-HUNDLEY
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 PICO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3808
Mailing Address - Country:US
Mailing Address - Phone:224-627-9113
Mailing Address - Fax:
Practice Address - Street 1:35000 GUADALCANAL AVE
Practice Address - Street 2:BLDG 596
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5599
Practice Address - Country:US
Practice Address - Phone:619-524-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider