Provider Demographics
NPI:1477692291
Name:LUND, PATRICIA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:E
Last Name:LUND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LIVE OAK AVE
Mailing Address - Street 2:#3
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4819
Mailing Address - Country:US
Mailing Address - Phone:650-327-4274
Mailing Address - Fax:
Practice Address - Street 1:700 LIVE OAK AVE
Practice Address - Street 2:#3
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4819
Practice Address - Country:US
Practice Address - Phone:650-327-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL126871Medicare ID - Type Unspecified