Provider Demographics
NPI:1497199848
Name:LAKIN, LISA J (IDC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LAKIN
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 1:1415 LEYTE RD APT C
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3180
Mailing Address - Country:US
Mailing Address - Phone:619-710-9128
Mailing Address - Fax:
Practice Address - Street 1:1415 LEYTE RD APT C
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3180
Practice Address - Country:US
Practice Address - Phone:619-710-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman