Provider Demographics
NPI:1477822294
Name:LEMON, MAURICE SR (M-RAS, CSC, NCAC I)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:LEMON
Suffix:SR
Gender:M
Credentials:M-RAS, CSC, NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3123
Mailing Address - Country:US
Mailing Address - Phone:510-276-7884
Mailing Address - Fax:510-276-6657
Practice Address - Street 1:1403 164TH AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3123
Practice Address - Country:US
Practice Address - Phone:510-276-7884
Practice Address - Fax:510-276-6657
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0508161628171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator